ZHENG Ruimin, Center for Women and Children’s Health, National Health Commission of China, Professor, M.D.

Winner of the 2022 APEC Healthy Women, Healthy Economies Research Prize.

She has undertaken over 20 projects on women's healthcare for the Ministry of Science and Technology of China, the National Health Commission of China, WHO, UNFPA, UNICEF, etc. She has published over 50 papers in core and SCI journals as the first or corresponding author. She is the chief editor or translator of more than ten specialized books. She is the corresponding author of Expert Consensus on Maternal Mental Health Management and Expert Consensus on Mental Health Management in Menopause Stage, the Chinese translator of the WHO Thinking healthy: a manual for psychosocial management of perinatal depression, and the Chinese translator of Mindful Birthing.

Academic Job:

• Chair, Capacity Building for Women’s Health Specialties Committee, China Maternal and Child Health Association
• Chair, Capacity Building for Women’s Health Committee, China Woman and Child Health Research Association
• Vice Chair, Maternal Mental Health Committee, China Maternal and Child Health Association
• Board Member, Reproductive Health Committee, Chinese Preventive Medicine Association
• Board Member, Menopausal Care Committee, Chinese Preventive Medicine Association
• Head of Psychosomatic Health Group & Deputy Head of Infertility Group, Reproductive Health Committee, Chinese Preventive Medicine Association
• Board Member, Mindfulness Committee, Chinese Psychological Society
• Board Member, Gynecological Endocrinology Committee, China Maternal and Child Health Association
• Board Member, Psychosomatic Medicine Committee, China Medical Women’s Association
• Board Member, Health Management Committee, China Medical Women’s Association
• Vice Chair, Maternal and Child Health Management Committee, China Medical Education Association
• Vice Chair, Menopausal Care Committee, China Woman and Child Health Research Association
• Editorial board member of Chinese Journal of Woman and Child Health Research and Chinese Journal of Women and Children’s Health

Effects of mindfulness-based psychosomatic program on fear of childbirth: a multi-center randomized controlled study

Objective

1. To evaluate the effects of mindfulness-based psychosomatic program on psychosomatic health and birth outcomes of pregnant women with fear of childbirth.
2. To explore whether changes of mindfulness and depression functioned as the underlying mechanisms of mindfulness-based psychosomatic program on fear of childbirth and to explore whether changes of mindfulness and depression functioned as the underlying mechanisms of mindfulness-based psychosomatic program on cortisol awakening response.

Methods

1. Implementation and data collection Subjects were recruited from Shandong Maternal and Child Health Hospital, Shandong Provincial Hospital and Shanxi Maternal and Child Health Hospital and were randomly divided into intervention group and control group from April to November 2023. Pregnant women in the control group received conventional maternal health education while pregnant women in the intervention group received mindfulness-based psychosomatic program on that basis. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), Five Facet Mindfulness Questionnaire (FFMQ), Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Scale (GAD-7) and State-Trait Anxiety Inventory (STAI) were used to evaluate the pregnant women before intervention, after intervention and 3 days after delivery. Saliva samples were collected before and after the intervention to detect cortisol secretion. Information on birth outcomes was collected postpartum.
2. Effectiveness analysis of interventions The mixed linear model was used to analyze the changes in scores of W-DEQ, FFMQ, EPDS, GAD-7, STAI as well as the changes in indicators of salivary cortisol awakening response between the two groups.
3. Analysis of mediation Pearson correlation analysis was used to analyze the correlation between the changes of W-DEQ, the changes of AUCI, the changes of FFMQ and the changes of EPDS before and after intervention. SPSS Amos 24.0 was used to test the chain mediation model, including the mediating effect of changes of FFMQ and EPDS between group and changes of W-DEQ as well as the mediating effect of changes of FFMQ and EPDS between group and changes of AUCI.

Results
1. Results of effectiveness analysis
The scores of W-DEQ in the intervention group decreased by 11.24 and 13.53 points after intervention and 3 days after delivery, respectively, with statistically significant differences (P<0.05). The scores of W-DEQ in the intervention group were lower than those in the control group after intervention and 3 days after delivery, with statistically significant differences (P<0.05).

The area under the curve with respect to increase of cortisol awakening response (AUCI), cortisol peak (PK), and slope from baseline to peak (SBP) in the intervention group increased after intervention and the AUCI and SBP were higher than those in the control group, with statistically significant differences (P<0.05).

The scores of FFMQ in the intervention group increased by 7.93 and 4.53 points after intervention and 3 days after delivery, respectively, with statistically significant differences (P<0.05). After the intervention and 3 days after delivery, the scores of FFMQ of the intervention group were higher than those of the control group, with statistically significant differences (P<0.05).

The scores of EPDS in the intervention group decreased by 1.03 and 1.64 points after intervention and 3 days after delivery, respectively, with statistically significant differences (P<0.05). After intervention and 3 days after delivery, the scores of EPDS of pregnant women in the intervention group were lower than those in the control group, with statistically significant differences (P<0.05).

The scores of STAI-S in the intervention group decreased by 4.03 points after intervention and the difference was statistically significant (P<0.05). After intervention and 3 days after delivery, the scores of STAI-S and GAD-7 of the intervention group were lower than those of the control group and the differences were statistically significant (P<0.05).

The proportion of labor analgesia use in the intervention group (37.2%) was lower than that in the control group (61.9%) and the proportion of oxytocin use in the second stage of labor in the intervention group (28.6%) was lower than that in the control group (64.0%), with statistically significant differences (P<0.05). In the cesarean section subgroup, the amount of blood loss at 2 hours postpartum in the intervention group (263.33±83.38 ml) was less than that in the control group (317.06±33.31 ml) and the difference was statistically significant (P<0.05). Among pregnant women with moderate fear of childbirth at baseline, the use of labor analgesia in the intervention group (31.0%) was lower than that in the control group (63.3%) and the differences were statistically significant (P<0.05). The proportion of natural delivery in the intervention group (78.6%) was higher than that in the control group (25.0%) and the differences were statistically significant (P<0.05).

2. Results of mediation analysis
The changes in the total score of W-DEQ before and after the intervention was negatively correlated with the changes of AUCI and the changes of FFMQ (r=-0.304, -0.396，P<0.01) as well as positively correlated with the changes of EDPS (r=0.455，P<0.01). The the changes of AUCI was positively correlated with the changes of FFMQ (r=0.443，P<0.01) and negatively correlated with the changes in the total score of EPDS (r=-0.295，P<0.01). The changes of FFMQ was negatively correlated with the changes in the total score of EPDS (r=-0.478，P<0.01).

The group could indirectly affect the changes of W-DEQ through the chain mediating effect of the changes of FFMQ and the changes of EDPS before and after intervention (effect value was -0.062 and 95%CI was -0.126~-0.015). The group could also indirectly affect the changes of AUCI through the mediating effect of the changes of FFMQ before and after intervention (effect value was 0.413 and 95%CI was 0.001~ 0.283).

Conclusion

1. The mindfulness-based psychosomatic program has an improvement effect on the psychosomatic health and delivery outcomes of pregnant women with fear of childbirth. The program significantly reduced fear of childbirth in pregnant women and increased the area under the curve with respect to increase of cortisol awakening response. The program also significantly reduced the proportion of labor analgesia and oxytocin use, and reduced the depression and anxiety of pregnant women with fear of childbirth.
2. Mindfulness-based psychosomatic program could improve the mindfulness level of pregnant women with fear of childbirth, thereby reducing depression and ultimately reducing the level of fear of childbirth. Mindfulness-based psychosomatic program could also increase the area under the curve with respect to increase of cortisol awakening response by improving the mindfulness level of pregnant women with fear of childbirth.

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