牡丹江医科大学学报

目的 基于潜变量混合增长模型分析妊娠早期入组初产妇孕期健康素养发展轨迹分类，并探讨其对产妇分娩恐惧的影响。方法 采用便利抽样法选取莆田九十五医院2023年10月至2024年10月在产科门诊行孕期保健的211例初产妇为研究对象，分别于妊娠12周(T1)、妊娠22周(T2)、妊娠30周(T3)、妊娠38周(T4)采用一般资料调查表、围生期健康素养量表、家庭关怀度指数量表、社会支持评定量表、分娩恐惧量表对产妇进行问卷调查。采用潜变量混合增长模型识别产妇健康素养发展轨迹，并采用单因素分析及多元线性回归方程分析产妇分娩恐惧的影响因素。结果 211例初产妇T1～T4时刻完整完成问卷共202例，有效回收率为95.73%。202例初产妇健康素养发展轨迹可分为稳定高健康素养组45例(22.28%)、中健康素养持续升高组122例(60.40%)及持续低健康素养组35例(17.33%)。初产妇分娩恐惧得分为(39.64±4.22)分。多元线性回归方程结果显示，该模型拟合良好(调整后R²=0.482,F=24.386,P<0.001);年龄(β=1.487,95%CI:0.323～2.651)、文化程度(β=-1.686,95%CI:-2.386～-0.986)、妊娠方式(β=1.103,95%CI:0.115～2.091)、意向分娩方式(β=1.033,95%CI:0.177～1.889)、健康素养发展轨迹(中健康素养持续升高组:β=2.246,95%CI:1.196～3.296;持续低健康素养组:β=3.922,95%CI:2.518～5.326)、家庭功能(β=0.864,95%CI:0.226～1.502)、社会支持(β=-1.724,95%CI:-2.390～-1.058)(均P<0.05)。结论 妊娠早期初产妇具有3种不同的健康素养发展轨迹，可显著影响产妇的分娩恐惧水平。

Objective To identify distinct developmental trajectories of health literacy among primiparas enrolled in early pregnancy using the Latent Growth Mixture Model(LGMM),and to examine its impact on maternal fear of childbirth(FOC). Methods A total of 211 primiparas receiving routine prenatal care at the obstetric clinic of Putian 95 th Hospital between October 2023 and October 2024 were recruited using convenience sampling. Data were collected at four time points: 12 gestational weeks(T1),22 gestational weeks(T2),30 gestational weeks(T3),and 38 gestational weeks(T4) using a sociodemographic questionnaire,the Perinatal Health Literacy Scale,Family APGAR Index,Social Support Rating Scale,and Fear of Childbirth Scale. Latent Growth Mixture Modeling was performed to identify heterogeneous trajectories of health literacy. Univariate analysis and multiple linear regression were conducted to determine factors associated with fear of childbirth. Results Of 211 primiparas,202 completed all follow-up assessments(T1-T4),yielding an effective response rate of 95.73%. Three distinct health literacy trajectories were identified: stable high health literacy(n =45,22.28%),moderate and increasing health literacy(n = 122,60.40%),and persistently low health literacy(n = 35,17.33%).The mean score for fear of childbirth was 39.64±4.22. Multiple linear regression revealed satisfactory model fit(adjusted R²= 0.482,F = 24.386,P<0.001). Significant predictors of fear of childbirth included age(β = 1.487,95%CI 0.323 to 2.651),educational level(β=-1.686,95%CI-2.386 to-0.986),pregnancy type(β= 1.103,95%CI 0.115 to 2.091),intended mode of delivery(β= 1.033,95%CI 0.177 to 1.889),health literacy trajectory(moderate and increasing group: β = 2.246,95% CI1.196 to3.296; persistently low group: β = 3.922,95%CI 2.518 to 5.326),family function(β = 0.864,95%CI 0.226 to 1.502),and social support(β =-1.724,95%CI-2.390 to-1.058)(all P<0.05). Conclusion Primiparas in early pregnancy present three heterogeneous health literacy trajectories that significantly predict the level of fear of childbirth.