Maternal Inner Strength Mediates the Longitudinal Association Between Family Emotional Expression and Fear of Childbirth: A Cross-Lagged Panel Mediation Analysis.

PURPOSE: Fear of childbirth (FOC) increases maternal and perinatal adverse health risks, and family factors are core predictors of FOC. This study aimed to clarify the mediating pathway through which familial emotional expression (FEE) is associated with FOC via pregnant women's inner strength (IS), so as to supply empirical basis for antenatal psychological risk management.

METHODS

A longitudinal survey was performed among pregnant women from the Department of Obstetrics and Gynecology of a tertiary Grade A hospital in Shenyang from September 2023 to August 2024. A total of 136 participants completed questionnaires in early, middle and late pregnancy, including the Childbirth Attitude Questionnaire (CAQ), Family Environment Scale (FES) and Inner Strength Scale (ISS). Two sets of longitudinal analyses were performed on this sample: latent class growth modeling (LCGM) was conducted via Mplus 8.3 to identify heterogeneous developmental trajectories of FOC; separately, cross-lagged panel mediation analyses were carried out with SPSS 26 and Amos 26.0 using the full-sample raw longitudinal data to examine the mediating mechanism among FEE, IS, and FOC.

RESULTS

Three distinct FOC developmental trajectories were identified: "Low FOC stable group" (11.4%), "Moderate FOC stable group" (33.5%), and "High FOC elevated group" (55.1%). FEE was longitudinally associated with IS (β=0.691, P<0.001), while IS was longitudinally associated with FOC in a negative direction (β=-0.552, P<0.001). No significant association was observed between FEE and FOC (β=0.079, P=0.293). The total effect of FEE on FOC was -0.303 (P<0.05), the direct effect was 0.079 (P>0.05), and the indirect effect was -0.382 (P<0.05), proving that the effect of FEE on FOC operates through IS.

CONCLUSIONS

FOC presents heterogeneous developmental trajectories across different gestational trimesters. FEE is indirectly associated with lower FOC levels by promoting pregnant women's IS. The findings provide empirical evidence for understanding the developmental characteristics and psychological influencing factors of FOC, and can inform targeted, individualized antenatal psychological screening and intervention strategies to alleviate childbirth fear and improve maternal mental health in clinical obstetric care.