Effects of preventive nursing based on quantitative evaluation on psychological state and maternal–infant outcome in patients with gestational diabetes mellitus

Abstract

Objective

To explore the effects of preventive nursing based on quantitative evaluation on psychological state and maternal–infant outcome in patients with gestational diabetes mellitus (GDM), further, to provide a theoretical basis for the effective management of GDM patients in clinical work.

Methods

From 1 February 2020 to 1 January 2021, 118 patients with GDM presenting to our hospital were included in this retrospective cohort study. According to the type of nursing care, patients were divided into study group and control groups. The study group consisted of 59 GDM patients who were given quantitative evaluation-based preventive nursing care. The control group included 59 GDM patients who were given routine nursing care. Outcome indicators included blood glucose level, degree of social support, resilience, coping style, and maternal–infant outcomes.

Results

There was no significant difference between two groups in other baseline clinical characteristics (p > .05). After the intervention, fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), and 2 h postprandial blood glucose (2hPBG) levels were significantly lower in the study group than that in the control group (p < .05). The scores of objective support, subjective support, and social support utilization in the study group were significantly higher than those in the control group after intervention (p < .05). The scores of optimisms, self-strengthening and tenacity in the study group were significantly less than those in the control group (p < .05). The study group confrontation score was significantly higher, and the avoidance and acceptance scores were significantly lower, compared with the control group (p < .05). The maternal–infant outcome showed that the proportions of cesarean delivery, pregnancy-induced hypertension, polyhydramnios, premature delivery, hyperbilirubinemia, and neonatal hypoglycemia in the study group were significantly lower than those in the control group (p < .05). There was no significant difference in the incidence of postpartum hemorrhage and neonatal 5-min Apgar score between the two groups (p > .05).

Conclusions

In conclusion, preventive nursing based on quantitative assessment can effectively control the blood glucose level of GDM patients, improve their degree of social support, resilience, coping style, and maternal–infant outcomes, which is worthy of clinical application.

Keywords:

• Preventive nursing
• quantitative evaluation
• gestational diabetes mellitus
• psychological state
• maternal–infant outcome

Introduction

Among women of childbearing age 20–49 years, 16.2% have some type of hyperglycemia during pregnancy, and gestational diabetes mellitus (GDM) accounts for approximately 90–95% of their total, referring to any degree of abnormal glucose tolerance first detected during pregnancy [1]. Globally, the incidence of GDM is increasing year by year and becomes a highly prevalent metabolic abnormality disease [2]. At present, the prevalence of GDM in different countries varies from 2% to 32%, of which the prevalence in developing countries has increased by more than 30% compared with 20 years ago, while the incidence of GDM in China is increasing year by year, about 17.5% [3]. The normal pregnancy and delivery process of pregnant women are affected by GDM, which increases the risk of adverse pregnancy outcomes [4]. In addition, studies have confirmed that about 60% of maternity with GDM will develop type 2 diabetes within 5–10 years after delivery, and most women will have transgenerational effects, meaning that their offspring are 2–8 times more likely to develop obesity, diabetes, hypertension, and kidney disease than normal maternity [4]. GDM has serious consequences for mothers and offspring, and it is particularly significant to seek methods to improve the situation of GDM. At present, the routine health education for GDM widely used in clinical practice, is based on one-way instillation and dominated by nursing staff, which does not effectively ameliorate the probability of adverse pregnancy outcomes [5]. It is important to find a more effective nursing intervention for GDM, which has become the focus of nurse clinician. Preventive care based on quantitative assessment refers to stratification based on blood glucose levels and psychological status of GDM patients, targeted preventive care. Preventive care methods based on quantitative assessment can effectively reduce postoperative complications and improve pregnancy outcomes in patients with gestational hypertension [6].

Herein, our study aimed to explore the effects of preventive nursing based on quantitative evaluation on psychological state and maternal–infant outcome in patients with GDM, further, to provide a theoretical basis for the effective management of GDM patients in clinical work.

Materials and methods

From 1 February 2020 to 1 January 2021, 118 patients with GDM presenting to our hospital were included in this retrospective cohort study. According to the type of nursing care, patients were divided into study group and control groups. The study group consisted of 59 GDM patients who were given quantitative evaluation-based preventive nursing care. The control group included 59 GDM patients who were given routine nursing care. This study protocol was formulated in accordance with the requirements of the Declaration of Helsinki of the World Medical Association. It was approved by the Ethics Committee of The First Hospital of Hebei Medical University (no. 20200624), and the informed consent forms were obtained from all patients.

Inclusion and exclusion criteria

Inclusion criteria: (1) Diagnosed of GDM according to the Guidelines for the Diagnosis and Treatment of Gestational Diabetes Mellitus (2014) [7]; (2) singleton pregnancy; (3) complete cognitive and behavioral ability; (4) regular prenatal examination and planned to deliver in study hospital; (5) able to communicate without obstacles; (6) accompanied by family members to participate.

Exclusion criteria: (1) Patients with diabetes before pregnancy; (2) patients with neurological diseases; (3) patients with abnormal consciousness; (4) patients with other serious systemic diseases; (5) patients with severe heart, kidney, and lung diseases; (6) patients with endocrine system diseases; (7) patients with infectious diseases; (8) patients with other diseases affecting blood glucose; (9) patients with other gestational diseases; (10) participants dropped out or are lost to follow-up.

Treatment protocol

Control group: Routine nursing intervention is given. Carry out health education, teach the patients to use glucometer, guide the patients to eat properly and remind them to exercise properly. Eating recipes are based on low fat, high protein, and high vitamins. After discharge, telephone follow-up is performed once a week. The patient is instructed to return to the hospital regularly once a week. Inform patients that abnormal blood glucose should be timely treated.

Study group: Preventive care based on quantitative assessment strategy is given. Quantitative evaluation scoring criteria: ① age (0 point under 30 years old, one point under 35 years old, two points over 35 years old); ② anxiety or depression (0 point without anxiety/depression, one point with mild anxiety/depression, two points with moderate anxiety/depression, three points with severe anxiety/depression); ③ complications (0 point without complications, one point for one kind of complication, two points for more than one kind of complication); ④ years of education (0 point for more than 12 years, one point for more than 6 years, two points for less than 6 years); ⑤ fasting blood glucose (FBG) level (0 point for <6.8 mmol/L, one point for <7.5 mmol/L, two points for >7.5 mmol/L). The total score is 0–11 points, of which 0–3 points is low risk level, 4–7 points is medium risk level, and ≥8 points is high risk level. Patients are given a stepped preventive intervention according to their risk level. The responsible nursing staff is responsible for adding patients and their families and informing them of the importance of companionship.

The intervention for low-risk patients is based on prevention. ① Cognitive intervention: the responsible nurse uses the centralized education model to explain the clinical manifestations and treatment plan of GDM for patients and their families, especially to tell the harm of GDM to maternal and child health and correct the previous wrong cognition; ② dietary intervention: regularly monitor the blood glucose level of patients every day, timely adjust the dietary recipe according to the blood glucose results, eat more easily digestible and high-fiber foods to ensure the needs of calories and nutrition during pregnancy; ③ exercise intervention: instruct patients to take a walk exercise 1–2 h after dinners, with the first time of 15 min, and then gradually increase the exercising time to avoid strenuous activity. ④ Prenatal intervention: explain the delivery process and diet and hygiene before delivery to the patients; ensure the caloric supply and adequate sleep of the patients; observe the uterine contraction and discomfort of the patients, and enter the waiting room when the cervix of the patients is >2 cm; ⑤ delivery intervention: closely monitor the patient’s consciousness and vital signs, assist the midwife to guide the patients to perform correct exertion and respiration, ensure the sterility of the delivery environment, communicate with the patients for psychological comfort and encouragement, timely observe whether the patients have discomfort, reduce the occurrence of various maternal and fetal complications; ⑥ postpartum intervention: continue to monitor the blood glucose of patient and neonate, reduce the occurrence of postpartum complications. Instruct patients to breastfeed; ⑦ psychological intervention: psychologists popularize the psychological knowledge of GDM, inform family members to pay more attention to the patient’s inner feelings, encourage them to carry out normal expression, and carry out targeted psychological intervention for patients with depressed mood or greater mood swings.

Medium risk patients add additional nutrition guidance, exercise guidance, and weight management to interventions for low-risk patients. ① Nutritional guidance: provide limited food types, dosage and cooking methods, all of which are high-protein and low-fat foods. Personalized recipes, such as fried-free steak, steamed fish and cold shrimp, are developed for patients to be low-fat and healthy under the condition of ensuring nutrition during pregnancy. The study of food consumption uses model and figurative analogy method, such as "fist" and "ID card" size to explain in order to facilitate patients to understand. ② Exercise guidance: different types of exercise are recommended according to the exercise habits of pregnant women, such as gymnastics during pregnancy, yoga, swimming, brisk walking, strength training, etc.; pregnant women with small amount of exercise at ordinary times are recommended to choose shopping walk, housework and other acceptable forms. ③ Weight management: weights of patients are measured and recorded once a week, and body weight change curves are plotted.

High-risk patients are given insulin as instructed on the basis of intervention methods for medium risk patients.

Observation indicators

Outcome indicators included blood glucose level, degree of social support, resilience, coping style, and maternal–infant outcomes. Blood glucose level, degree of social support, resilience, and coping style were measured before and after intervention in both groups. The timing of indicator measurements was one day before and three months after the intervention. The levels of various indicators before the intervention were used as the baseline levels of indicator. Maternal–infant outcomes were measured and recorded in both groups.

Blood glucose level: Venous blood was collected from the patients, and the upper serum was separated by centrifugation. The glycosylated hemoglobin (HbA1c) in the serum was measured by high performance liquid chromatography. The 2 h postprandial blood glucose (2hPBG) and FBG levels were measured by Beckman AU5800 automatic biochemical analyzer (Brea, CA).

Degree of social support: Assessed according to the Social Support Rating Scale [8]: this scale has 10 items in three dimensions including objective support, subjective support, and social support utilization. The total score is 66 points, and a higher score indicates a better degree of social support.

Resilience: Patients were evaluated using the Chinese version of Resilience Scale [9]. The scale includes three dimensions of optimism, self-strengthening, tenacity, with a total of 25 items, each of which is 0–4, for a total score of 0–100. The higher the score, the higher the level of resilience.

Coping styles: Assessed using the Medical Coping styles Questionnaire (MCMQ) [10]. The scale consists of three sub-scales (confrontation, avoidance, acceptance), which are 8–32 points, 7–28 points, and 5–20 points. The lower the scores of avoidances and yield, the more correct the patient’s coping style. The higher the confrontation score, the lower the avoidance and acceptance scores, the more correct the patient’s coping style.

Maternal–infant outcomes: The indicators of maternal–infant outcomes included mode of delivery, incidence of pregnancy-induced hypertension, polyhydramnios, premature rupture of membranes, premature delivery, hyperbilirubinemia, neonatal hypoglycemia and postpartum hemorrhage, and neonatal 5-min Apgar score.

Statistical analysis

All the data collected in this study were analyzed using SPSS 21.0 software (SPSS Inc., Chicago, IL). The normality of continuous variables was tested by the Shapiro–Wilk test as well as the graphical illustration of histograms and Q–Q plots. Normally distributed measurement data were expressed as mean ± standard deviation (SD), while non-normally distributed measurement data were expressed as median (interquartile range), and the comparisons were examined by Student’s t-test and Mann–Whitney’s test (non-parametric distribution). The categorical data were expressed as n (%), and the differences between the two groups were examined by Chi-square analysis or Fisher’s exact test. The statistical significance level was set at .05 for a two-sided test.

Results

Baseline clinical characteristics

The study group consisted of 59 women, ranging in age from 24 to 35 years old, with a mean age of (26.67 ± 6.83) years old. The control group consisted of 59 women, ranging in age from 23 to 35 years old, with a mean age of (26.62 ± 6.792) years old. There was no significant difference between two groups in other baseline clinical characteristics (p> .05) (Table 1).

Table 1. Baseline clinical characteristics.

Clinical characteristics	Study group (n = 59)	Control group (n = 59)	χ^2/t	p
Age, (years)	26.67 ± 6.83	26.62 ± 6.79	0.039	.968
BMI (kg/m^2)	28.76 ± 3.19	28.72 ± 3.13	0.069	.945
Primipara, n (%)	32 (54.24%)	33 (55.93%)	0.034	.853
Gestational weeks(weeks)	25.31 ± 1.91	25.28 ± 1.84	–0.203	.839
Number of pregnancy	3.38 ± 1.04	3.41 ± 1.05	–0.156	.876
Number of deliveries	1.82 ± 0.32	1.78 ± 0.41	0.591	.556
Blood glucose level
FBG (mmol/L)	8.87 ± 2.01	8.81 ± 1.94	0.137	.891
HbA1c (%)	9.34 ± 2.03	9.31 ± 2.01	0.081	.936
2hPBG (mmol/L)	13.78 ± 2.18	13.72 ± 2.13	0.155	.879
Degree of social support
Objective support (points)	8.69 ± 1.51	8.72 ± 1.57	–0.106	.916
Subjective support (points)	16.28 ± 2.13	16.31 ± 2.18	–0.076	.939
Social support utilization (points)	6.98 ± 1.23	7.03 ± 1.27	–0.217	.829
Total score (points)	31.95 ± 4.87	33.51 ± 5.02	–1.713	.089
Resilience
Optimism (points)	6.63 ± 0.39	6.69 ± 0.43	–0.794	.429
Self-strengthening (points)	13.02 ± 2.09	13.07 ± 2.13	–0.129	.898
Tenacity (points)	21.23 ± 2.31	21.29 ± 2.39	–0.139	.889
Total score (points)	40.88 ± 4.79	41.03 ± 4.95	–0.167	.868
Coping styles
Confrontation (points)	14.87 ± 1.76	14.93 ± 1.79	–0.184	.854
Avoidance (points)	18.93 ± 1.73	18.96 ± 1.71	–0.095	.924
Acceptance (points)	15.09 ± 2.07	15.03 ± 2.02	0.159	.874

BMI: body mass index; FBG: fasting blood glucose; HbA1c: glycosylated hemoglobin; 2hPBG: 2 h postprandial blood glucose.

Comparison of blood glucose level

In both groups, the FBG, HbA1c, and 2hPBG levels after intervention were significantly decreased compared with those before intervention (p< .05). After the intervention, FBG, HbA1c, and 2hPBG levels were significantly lower in the study group than that in the control group (p< .05) (Table 2).

Table 2. Comparison of blood glucose level after intervention.

Blood glucose level	Study group (n = 59)	Control group (n = 59)	χ^2/t	p
FBG (mmol/L)	4.83 ± 1.21	5.47 ± 1.96	–2.134	.035
HbA1c (%)	5.32 ± 2.02	6.12 ± 1.93	–2.199	.031
2hPBG (mmol/L)	5.21 ± 1.76	6.02 ± 1.83	–2.448	.016

FBG: fasting blood glucose; HbA1c: glycosylated hemoglobin; 2hPBG: 2 h postprandial blood glucose.

Comparison of degree of social support

In both groups, the scores of objective support, subjective support, and social support utilization after intervention were significantly higher than those before intervention (p< .05). After intervention, the scores of objective support, subjective support, and social support utilization in the study group were significantly higher than those in the control group (p< .05) (Table 3).

Table 3. Comparison of degree of social support after intervention.

Degree of social support	Study group (n = 59)	Control group (n = 59)	χ^2/t	p
Objective support (points)	15.88 ± 1.65	12.82 ± 1.61	10.196	<.001
Subjective support (points)	29.38 ± 1.76	24.39 ± 1.73	15.531	<.001
Social support utilization (points)	11.67 ± 1.34	8.48 ± 1.41	12.597	<.001
Total score (points)	56.93 ± 4.75	45.69 ± 4.75	12.852	<.001

Comparison of resilience

In both groups, the scores of optimisms, self-strengthening and tenacity after intervention were significantly less than those before intervention (p< .05). After intervention, the scores of optimisms, self-strengthening and tenacity in the study group were significantly less than those in the control group (p< .05) (Table 4).

Table 4. Comparison of resilience after intervention.

Resilience	Study group (n = 59)	Control group (n = 59)	χ^2/t	p
Optimism (points)	8.89 ± 0.41	7.63 ± 0.48	15.331	<.001
Self-strengthening (points)	23.43 ± 2.11	18.07 ± 2.06	13.962	<.001
Tenacity (points)	33.29 ± 2.43	27.01 ± 2.31	14.387	<.001
Total score (points)	65.61 ± 4.95	52.71 ± 4.85	14.298	<.001

Comparison of coping styles

In both groups, the confrontation score significantly increased, and the avoidance and acceptance scores significantly decreased after the intervention, compared with those before the intervention (p< .05). After the intervention, the study group confrontation score was significantly higher, and the avoidance and acceptance scores were significantly lower, compared with the control group (p< .05) (Table 5).

Table 5. Comparison of coping styles after intervention.

Coping styles	Study group (n = 59)	Control group (n = 59)	χ^2/t	p
Confrontation (points)	24.39 ± 1.83	21.09 ± 1.82	9.821	<.001
Avoidance (points)	11.71 ± 2.31	14.76 ± 2.28	–7.218	<.001
Acceptance (points)	8.23 ± 1.21	9.34 ± 1.27	–4.861	<.001

Comparison of maternal–infant outcomes

The proportions of cesarean delivery, pregnancy-induced hypertension, polyhydramnios, premature delivery, hyperbilirubinemia, and neonatal hypoglycemia in the study group were significantly lower than those in the control group (p< .05). There was no significant difference in the incidence of postpartum hemorrhage and neonatal 5-min Apgar score between the two groups (p> .05) (Table 6).

Table 6. Comparison of maternal–infant outcomes.

Maternal–infant outcomes	Study group (n = 59)	Control group (n = 59)	χ^2/t	p
Mode of delivery
Cesarean delivery, n (%)	12 (20.34)	29 (49.15)	10.802	.001
Natural birth, n (%)	47 (79.66)	30 (50.85)
Pregnancy-induced hypertension, n (%)	0	6 (10.17)	10.796	.002
Polyhydramnios, n (%)	0	6 (10.17)	10.796	.002
Premature rupture of membranes, n (%)	0	6 (10.17)	10.796	.002
Preterm birth, n (%)	1 (1.69)	8 (13.56)	5.894	.015
Hyperbilirubinemia, n (%)	1 (1.69)	8 (13.56)	5.894	.015
Neonatal hypoglycemia, n (%)	0	8 (13.56)	5.894	.015
Neonatal 5-minute Apgar score (points)	95.23 ± 1.29	95.18 ± 1.23	0.215	.828
Postpartum hemorrhage, n (%)	0	3 (5.08)	3.078	.079

Discussion

GDM is one of the common obstetric complications, mainly due to changes in hormones in the body, which leads to a significant decrease in the patient’s sensitivity to insulin [11]. Further development of the disease can lead to abnormal changes in glucose metabolism, ultimately inducing the occurrence of a series of maternal and fetal complications [11]. The International Diabetes Conference proposes a treatment of diet combined with exercise for GDM patients, but the effect of home self-exercise exercise and dietary intervention is often poor after patients discharged from the hospital [12]. The adverse effects and degree of impact of GDM on mothers and infants mainly depend on the progression of GDM and the status of blood glucose. In clinical practice, GDM is extremely likely to trigger a variety of perinatal and neonatal complications if not intervened promptly, greatly threatening the quality of life of mothers and infant [13]. Persistent hyperglycemia in GDM patients can cause extensive maternal vascular disease, so that the vascular endothelium thickens, the blood vessels gradually narrow, and finally make the blood supply of tissues and organs relatively insufficient, causing proteinuria, pregnancy-induced hypertension, eclampsia, and so on [14]. Transplacental entry of glucose into the fetus can cause fetal hyperglycemia and further develop into macrosomia, which increases the incidence of complications such as neonatal asphyxia, birth canal laceration, premature rupture of membranes, iatrogenic premature delivery, and puerperal infection [14].

Preventive care based on quantitative assessment divided GDM patients into different risk levels such as lower risk, moderate risk, and high risk through disease assessment, and ladder nursing interventions were given, which can effectively control blood glucose levels and change maternal and fetal outcomes [6]. Some studies pointed out that effective interventions could significantly control blood glucose levels in GDM patients, reduced the occurrence of GDM related complications, and improved pregnancy outcomes [15,16]. The current study showed that, FBG, HbA1c, and 2hPBG levels were significantly lower in the study group than that in the control group after intervention, suggesting that preventive care based on quantitative assessment can effectively reduce blood glucose levels in GDM patients. Diet and exercise intervention in preventive nursing is helpful to control blood glucose level during pregnancy, which is consistent with relevant studies [12,17].

Social support refers to the spiritual and material help provided by all social relationships owned by individuals, and good social support can promote patients to adapt to the disease as soon as possible and straighten the attitude of learning disease knowledge, improving patients’ compliance with medical care [18]. Social support plays a crucial role in maintaining and enhancing physical and mental health and can reduce the phenomenon of affective disorders, so clinical attention should be paid to social support for GDM patients [18,19]. There are currently relatively few studies on the application of preventive care based on quantitative evaluation in GDM. The results of current study showed the scores of objective support, subjective support, and social support utilization in the study group were significantly higher than those in the control group after intervention, suggesting that preventive care based on quantitative assessment can improve social support in GDM patients. After analyzing the reasons, we believed that preventive care emphasizes that family companionship played an important role, which promoting GDM patients to actively use various social resources so as to improve the patient’s social support system.

In recent years, as a part of positive psychology, resilience has become a hot field of research at home and abroad. It is an ability to correctly face negative experiences and maintain mental health and plays a role in protecting emotions in daily life [20]. Personal resilience can stimulate the internal positive psychological quality, which effectively improves the subjective well-being and quality of life [20]. Previous studies have pointed out that poor compliance in GDM patients is closely related to resilience, while effective nursing interventions can improve resilience in GDM patients [21,22]. The enhancement of resilience is beneficial to improve the patient’s ability to manage GDM. Our study showed the scores of optimisms, self-strengthening and tenacity in the study group were significantly less than those in the control group after intervention, suggesting that preventive care based on quantitative assessment can improve the level of resilience in GDM patients. Preventive care required the patient and his/her family to care for the patient’s inner feelings, encouraged their expression, and performed targeted psychological intervention for patients with depressed mood or greater mood swings. This improved patients’ confidence in treating the disease and prompted patients to adopt a positive attitude to face the disease.

Coping style is a stable cognitive activity and behavioral activity shown by individuals in response to various stressful events, of which, confrontation belongs to positive coping style, and both avoidance and acceptance belong to negative coping style. Previous studies have pointed out that attitudes of avoidance and acceptance were prevalent in diabetic patients [23]. Adopting an active coping style in GDM patients contributes to better self-management of diabetes [23]. The results showed the study group confrontation score was significantly higher, and the avoidance and acceptance scores were significantly lower, compared with the control group after intervention. The study preventive nursing uses a variety of active coping styles, and at the same time, targeted intervention measures are taken to promote the patient to actively face GDM according to the severity of the patient’s condition, so as to effectively control the condition.

GDM disease can affect normal maternal–infant outcome. First, it may increase the proportion of cesarean section, increasing the risk of surgical trauma and postoperative complications and affecting postpartum quality of life [24]. Second, GDM may lead to various types of pregnancy complications, such as premature delivery, premature rupture of membranes, polyhydramnios, and gestational hypertension [25–28]. Among them, gestational hypertension is a more serious complication of pregnancy, which is mainly characterized by elevated blood pressure. In more severe cases, convulsions, coma, and multiple organ dysfunction will occur, ultimately resulting in maternal and fetal death [26]. Other common abnormal fetal outcomes and surgery-related complications also include neonatal hyperbilirubinemia, neonatal hypoglycemia, and postpartum hemorrhage [29–31]. Postpartum hemorrhage is the leading cause of pregnancy-related death [21]. Neonatal 5-min Apgar score is an important basis for evaluating the short-term and long-term prognosis of neonates [32]. We selected the above situation as the observation indicator of maternal–infant outcome. These results of current study showed the proportions of cesarean delivery, pregnancy-induced hypertension, polyhydramnios, premature delivery, hyperbilirubinemia, and neonatal hypoglycemia in the study group were significantly lower than those in the control group, suggesting that preventive care based on quantitative assessment can effectively improve the maternal–infant outcomes in GDM patients, which is similar to the results of previous studies [33].

A shortcoming of this study was that the weight change and the rate of change in patients with gestational diabetes were not analyzed. Another limitation was that the follow-up time was short, and no relevant data on the long-term effects of offspring of GDM patients, such as blood glucose levels, were collected. In the further study, we will set a more comprehensive observation index and conduct a longer and large randomized controlled study to provide a theoretical basis for the subsequent application of relevant preventive nursing care.

Conclusions

In conclusion, preventive nursing based on quantitative assessment can effectively control the blood glucose level of GDM patients, improve their degree of social support, resilience, coping style, and maternal–infant outcomes, which is worthy of clinical application.

Author contributions

LHL, ZMX, and LHX contributed to the conception and design of the study; LXD, WJ, and WP performed the experiments, collected and analyzed data; LHL, ZMX, and LHX wrote the manuscript; all authors reviewed and approved the final version of the manuscript.

Ethical approval

This study protocol was formulated in accordance with the requirements of the Declaration of Helsinki of the World Medical Association. It was approved by the Ethics Committee of The First Hospital of Hebei Medical University (no. 20200624).

Consent form

The informed consent forms were obtained from all patients.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study was funded by Medical Science Research Project of Hebei Provincial Health Commission (No. 20221438).