Construction and validation of a nomogram prediction model for the risk of pregnant women's fear of childbirth_Chinese Journal of Evidence-Based Medicine

Authors：

HUANG Liping ¹ , DONG Zhixia ² , YANG Yifeng ³ ,  TANG Huiyan ^1,4

1. College of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan 063210, P. R. China;
2. Department of Obstetrics and Gynecology, Fengnan District Hospital of Traditional Chinese Medicine, Tangshan 063300, P. R. China;
3. Obstetrics Clinic, Tangshan Maternal and Child Health Hospital, Tangshan 063000, P. R. China;
4. Department of Medical, Tianjin Tianshi College, Tianjin 301700, P. R. China;

Corresponding author：

TANG Huiyan, Email: tanghuiyan2008@163.com

Keywords：

Fear of childbirth; Pregnant women; Risk factor; Nomogram; Prediction model

DOI：

10.7507/1672-2531.202307048

Video：

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Objective To construct and verify the nomogram prediction model of pregnant women's fear of childbirth. Methods A convenient sampling method was used to select 675 pregnant women in tertiary hospital in Tangshan City, Hebei Province from July to September 2022 as the modeling group, and 290 pregnant women in secondary hospital in Tangshan City from October to December 2022 as the verification group. The risk factors were determined by logistic regression analysis, and the nomogram was drawn by R 4.1.2 software. Results Six predictors were entered into the model: prenatal education, education level, depression, pregnancy complications, anxiety and preference for delivery mode. The areas under the ROC curves of the modeling group and the verification group were 0.834 and 0.806, respectively. The optimal critical values were 0.113 and 0.200, respectively, with sensitivities of 67.2% and 77.1%, the specificities were 87.3% and 74.0%, and the Jordan indices were 0.545 and 0.511, respectively. The calibration charts of the modeling group and the verification group showed that the coincidence degree between the actual curve and the ideal curve was good. The results of Hosmer-Lemeshow goodness of fit test were χ²=6.541 (P=0.685) and χ²=5.797 (P=0.760), and Brier scores were 0.096 and 0.117, respectively. DCA in modeling group and verification group showed that when the threshold probability of fear of childbirth were 0.00 to 0.70 and 0.00 to 0.70, it had clinical practical value. Conclusion The nomogram model has good discrimination, calibration and clinical applicability, which can effectively predict the risk of pregnant women's fear of childbirth and provide references for early clinical identification of high-risk pregnant women and targeted intervention.

Citation： HUANG Liping, DONG Zhixia, YANG Yifeng, TANG Huiyan. Construction and validation of a nomogram prediction model for the risk of pregnant women's fear of childbirth. Chinese Journal of Evidence-Based Medicine, 2024, 24(2): 155-163. doi: 10.7507/1672-2531.202307048 Copy

1.	Ringler M, Pavelka R. Fear of childbirth - definition and description of the term on the basis of empirical data (author's transl). Z Geburtshilfe Perinatol, 1982, 186(1): 55-57.
2.	Sanjari S, Chaman R, Salehin S, et al. Update on the global prevalence of severe fear of childbirth in low-risk pregnant women: a systematic review and meta-analysis. IJWHR, 2022, 10(1): 3-10.
3.	高昌霞, 林翠萍, 董莉, 等. 孕妇分娩恐惧的影响因素分析. 中华现代护理杂志, 2022, 28(4): 531-534.
4.	Sanni KR, Eeva E, Noora SM, et al. The influence of maternal psychological distress on the mode of birth and duration of labor: findings from the FinnBrain Birth Cohort Study. Arch Womens Ment Health, 2022, 25(2): 463-472.
5.	Dencker A, Nilsson C, Begley C, et al. Causes and outcomes in studies of fear of childbirth: a systematic review. Women Birth, 2019, 32(2): 99-111.
6.	中华预防医学会心身健康学组, 中国妇幼保健协会妇女心理保健技术学组. 孕产妇心理健康管理专家共识(2019年). 中国妇幼健康研究, 2019, 30(7): 781-786.
7.	闫高慧, 燕美琴, 任永莲, 等. 孕晚期孕妇分娩恐惧风险预测模型的构建及验证. 护理研究, 2022, 36(21): 3810-3815.
8.	Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: more than meets the eye. Lancet Oncol, 2015, 16(4): e173-e180.
9.	衡鑫, 邓俊, 张佩芸等. COPD合并心力衰竭患者短期死亡风险的列线图模型. 中国循证医学杂志, 2023, 23(3): 272-278.
10.	高永祥, 张晋昕. Logistic回归分析的样本量确定. 循证医学, 2018, 18(2): 122-124.
11.	Wijma K, Wijma B, Zar M. Psychometric aspects of the W-DEQ: a new questionnaire for the measurement of fear of childbirth. J Psychosom Obstet Gynaecol, 1998, 19(2): 84-97.
12.	赵亚楠, 李燕, 张静, 等. 基于共识的健康测量工具遴选标准对分娩恐惧量表测量属性的系统评价. 中华护理教育, 2022, 19(4): 378-384.
13.	Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med, 2001, 16(9): 606-613.
14.	Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med, 2006, 166(10): 1092-1097.
15.	姜乾金. 心理卫生评定量表手册. 北京: 中国心理卫生杂志出版社, 1999.
16.	Hassanzadeh R, Abbas-Alizadeh F, Meedya S, et al. Fear of childbirth, anxiety and depression in three groups of primiparous pregnant women not attending, irregularly attending and regularly attending childbirth preparation classes. BMC Womens Health, 2020, 20(1): 180.
17.	姜乾金, 马辛, 林大熙, 等. 医学心理学(第2版). 北京: 人民卫生出版社, 2010.
18.	Onchonga D. Prenatal fear of childbirth among pregnant women and their spouses in Kenya. Sex Reprod Healthc, 2021, 27: 100593.
19.	Qiu L, Sun N, Shi X, et al. Fear of childbirth in nulliparous women: a cross-sectional multicentre study in China. Women Birth, 2020, 33(2): e136-e141.
20.	Molgora S, Fenaroli V, Prino LE, et al. Fear of childbirth in primiparous Italian pregnant women: the role of anxiety, depression, and couple adjustment. Women Birth, 2018, 31(2): 117-123.
21.	Nguyen LD, Nguyen LH, Ninh LT, et al. Fear of childbirth and preferences for prevention services among urban pregnant women in a developing country: a multicenter, cross-sectional study. Int J Environ Res Public Health, 2021, 18(10): 5382.
22.	Berhanu RD, Abathun AD, Negessa EH, et al. The magnitude and associated factors of childbirth fear among pregnant women attending antenatal care at public hospitals in Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth, 2022, 22(1): 222.
23.	Gelaw T, Ketema TG, Beyene K, et al. Fear of childbirth among pregnant women attending antenatal care in Arba Minch town, southern Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth, 2020, 20(1): 672.
24.	Hendrix Y, Baas M, Vanhommerig J, et al. Prevalence and course of fear of childbirth during pregnancy and need for help in nulliparous women: a cohort study. J Reprod Infant Psyc, 2022, 40(2): 245-254.
25.	Khosravi P, Pirdadeh Beiranvand S, Beiranvand B, et al. Relationship between Primigravid women's awareness, attitude, fear of childbirth, and mode of delivery preference. Eur J Obstet Gynecol Reprod Biol X, 2022, 14: 100143.
26.	Jaju S, Al Kharusi L, Gowri V. Antenatal prevalence of fear associated with childbirth and depressed mood in primigravid women. Indian J Psychiatry, 2015, 57(2): 158-161.
27.	Şahin S, Güler DS, Özdemir K, et al. Assessment of level of knowledge on childbirth and fear of childbirth among pregnant women. Med J Bakirkoy, 2019, 15(1): 5-14.
28.	Zhou X, Liu H, Li X, et al. Fear of childbirth and associated risk factors in healthy pregnant women in northwest of China: a cross-sectional study. Psychol Res Behav Manag, 2021, 14: 731-741.
29.	Mandar O, Idrees MB, Ahmed A, et al. Prevalence and associated factors of fear for childbirth among pregnant women in eastern Sudan. J Reprod Infant Psychol, 2023, 41(3): 319-329.

1. Ringler M, Pavelka R. Fear of childbirth - definition and description of the term on the basis of empirical data (author's transl). Z Geburtshilfe Perinatol, 1982, 186(1): 55-57.
2. Sanjari S, Chaman R, Salehin S, et al. Update on the global prevalence of severe fear of childbirth in low-risk pregnant women: a systematic review and meta-analysis. IJWHR, 2022, 10(1): 3-10.
3. 高昌霞, 林翠萍, 董莉, 等. 孕妇分娩恐惧的影响因素分析. 中华现代护理杂志, 2022, 28(4): 531-534.
4. Sanni KR, Eeva E, Noora SM, et al. The influence of maternal psychological distress on the mode of birth and duration of labor: findings from the FinnBrain Birth Cohort Study. Arch Womens Ment Health, 2022, 25(2): 463-472.
5. Dencker A, Nilsson C, Begley C, et al. Causes and outcomes in studies of fear of childbirth: a systematic review. Women Birth, 2019, 32(2): 99-111.
6. 中华预防医学会心身健康学组, 中国妇幼保健协会妇女心理保健技术学组. 孕产妇心理健康管理专家共识(2019年). 中国妇幼健康研究, 2019, 30(7): 781-786.
7. 闫高慧, 燕美琴, 任永莲, 等. 孕晚期孕妇分娩恐惧风险预测模型的构建及验证. 护理研究, 2022, 36(21): 3810-3815.
8. Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: more than meets the eye. Lancet Oncol, 2015, 16(4): e173-e180.
9. 衡鑫, 邓俊, 张佩芸等. COPD合并心力衰竭患者短期死亡风险的列线图模型. 中国循证医学杂志, 2023, 23(3): 272-278.
10. 高永祥, 张晋昕. Logistic回归分析的样本量确定. 循证医学, 2018, 18(2): 122-124.
11. Wijma K, Wijma B, Zar M. Psychometric aspects of the W-DEQ: a new questionnaire for the measurement of fear of childbirth. J Psychosom Obstet Gynaecol, 1998, 19(2): 84-97.
12. 赵亚楠, 李燕, 张静, 等. 基于共识的健康测量工具遴选标准对分娩恐惧量表测量属性的系统评价. 中华护理教育, 2022, 19(4): 378-384.
13. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med, 2001, 16(9): 606-613.
14. Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med, 2006, 166(10): 1092-1097.
15. 姜乾金. 心理卫生评定量表手册. 北京: 中国心理卫生杂志出版社, 1999.
16. Hassanzadeh R, Abbas-Alizadeh F, Meedya S, et al. Fear of childbirth, anxiety and depression in three groups of primiparous pregnant women not attending, irregularly attending and regularly attending childbirth preparation classes. BMC Womens Health, 2020, 20(1): 180.
17. 姜乾金, 马辛, 林大熙, 等. 医学心理学(第2版). 北京: 人民卫生出版社, 2010.
18. Onchonga D. Prenatal fear of childbirth among pregnant women and their spouses in Kenya. Sex Reprod Healthc, 2021, 27: 100593.
19. Qiu L, Sun N, Shi X, et al. Fear of childbirth in nulliparous women: a cross-sectional multicentre study in China. Women Birth, 2020, 33(2): e136-e141.
20. Molgora S, Fenaroli V, Prino LE, et al. Fear of childbirth in primiparous Italian pregnant women: the role of anxiety, depression, and couple adjustment. Women Birth, 2018, 31(2): 117-123.
21. Nguyen LD, Nguyen LH, Ninh LT, et al. Fear of childbirth and preferences for prevention services among urban pregnant women in a developing country: a multicenter, cross-sectional study. Int J Environ Res Public Health, 2021, 18(10): 5382.
22. Berhanu RD, Abathun AD, Negessa EH, et al. The magnitude and associated factors of childbirth fear among pregnant women attending antenatal care at public hospitals in Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth, 2022, 22(1): 222.
23. Gelaw T, Ketema TG, Beyene K, et al. Fear of childbirth among pregnant women attending antenatal care in Arba Minch town, southern Ethiopia: a cross-sectional study. BMC Pregnancy Childbirth, 2020, 20(1): 672.
24. Hendrix Y, Baas M, Vanhommerig J, et al. Prevalence and course of fear of childbirth during pregnancy and need for help in nulliparous women: a cohort study. J Reprod Infant Psyc, 2022, 40(2): 245-254.
25. Khosravi P, Pirdadeh Beiranvand S, Beiranvand B, et al. Relationship between Primigravid women's awareness, attitude, fear of childbirth, and mode of delivery preference. Eur J Obstet Gynecol Reprod Biol X, 2022, 14: 100143.
26. Jaju S, Al Kharusi L, Gowri V. Antenatal prevalence of fear associated with childbirth and depressed mood in primigravid women. Indian J Psychiatry, 2015, 57(2): 158-161.
27. Şahin S, Güler DS, Özdemir K, et al. Assessment of level of knowledge on childbirth and fear of childbirth among pregnant women. Med J Bakirkoy, 2019, 15(1): 5-14.
28. Zhou X, Liu H, Li X, et al. Fear of childbirth and associated risk factors in healthy pregnant women in northwest of China: a cross-sectional study. Psychol Res Behav Manag, 2021, 14: 731-741.
29. Mandar O, Idrees MB, Ahmed A, et al. Prevalence and associated factors of fear for childbirth among pregnant women in eastern Sudan. J Reprod Infant Psychol, 2023, 41(3): 319-329.

Chinese Journal of Evidence-Based Medicine

Construction and validation of a nomogram prediction model for the risk of pregnant women's fear of childbirth

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