Physical and psychological well-being in working nulliparous women during pregnancy

Abstract

The aim of this prospective study on 170 nulliparous women was to evaluate physical and psychological well-being during pregnancy as reported on the Hopkins Symptom Checklist (HSCL) and the Bradburn Affect Balance Scale, administered at 18 and 34 weeks' gestation. Moreover, for the 133 women in paid employment, variables related to various aspects of well-being were assessed.

The HSCL and the Bradburn Scale were evaluated with regard to their factor-structure to measure physical and psychological well-being during pregnancy. Principal component analysis of the HSCL showed three independent factors: a depression, a somatic symptom and an anxiety dimension. The Bradburn Scale was used as a measure of overall psychological well-being; its two independent positive and negative affect sub-scales could not be replicated. Psychological and physical changes accompanying normal pregnancy influenced the response to these scales; the need for cartful evaluation of the use of well-being scales during pregnancy is stressed.

Compared with non-pregnant reference groups, we found normal well-being during pregnancy, and we also found indications for a positive effect of employment on well-being.

In the employed women, step-wise multiple regression analyses on the three HSCL factors and Bradburn Scale were performed at 18 and 34 weeks' gestation in order to evaluate the relationship of well-being with demographic variables; health prior to pregnancy; support and self-esteem; employment variables; and pregnancy-related variables.

At both points of measurement, depression was mainly explained by self-esteem and support variables; somatic symptoms mainly by pregnancy-related variables. Associated with anxiety were occupational level at the 18th gestational week and pregnancy complaints at the 34th week. The total variance explained by the multiple regression analyses of the three HSCL factors taken together was 68.8% at the 18th week and 63.9% at the 34th week of gestation. The difference in the number and severity of symptoms reported on the three sub-scales together at the 18th and 34th gestational week could be predicted for 54-2%.

The total explained variance of the Bradburn Scale was only 29.4% and 20.3% for the two measurements respectively. A relationship with self-esteem was found at both measurements, while support variables also contributed to the explained variance at the 18th gestational week. The intensity of fatigue was the sole pregnancy-related variable related to this scale, accounting for a small variance at the 34th gestational week. Job satisfaction was the only variable related to an increase in overall psychological well-being during pregnancy.