Abstract:

Objective To explore the trajectory of psychological symptom clusters in pregnant women with assisted reproductive technology（ART），and analyze the influencing factors of each trajectory subgroups，in order to provide a theoretical basis for the management of psychological health during pregnancy in pregnant women with ART. Methods A total of 205 pregnant women who had conceived using ART were sampled from the obstetrics clinic of a tertiary hospital in Nanjing from August 2023 to April 2024 using a convenient sampling method. The baseline data were assessed by general information questionnaire，Symptom Checklist-90，Distress Disclosure Index and Positive Psychological Capital Questionnaire at 10-14 weeks gestation，and the follow-up information was assessed by Symptom Checklist-90 at 22-26 weeks of gestation and 34-38 weeks of gestation. Exploratory factor analysis was used to extract symptom clusters；the latent class growth mixture model was used to identify the track categories；the multiple logistic regression analysis was used to analyze the influencing factors of the track. Results 180 cases were finally included. By exploratory factor analysis，5，4 and 5 factors were extracted at 3 time points respectively. Trajectories of psychological symptom clusters in pregnant women with ART is divided into 3 potential classes：low level-slow relieving group（28.89%），high level-significant increasing group（6.11%），medium level-slow increasing group（65.00%）. Logistic regression analyses showed that duration of infertility，number of ART，literacy，pain self-expression and positive psychological capital were influential factors in the potential categories of psychological symptom clusters in pregnant women conceived with ART（all P<0.05）. Conclusion The trajectory of psychological symptom clusters in pregnant women with ART was divided into 3 potential classes. Medical workers could develop corresponding interventions based on the influencing factors and implement comprehensive and efficient symptom management.

Key words: Assisted Reproductive Technology, Psychological Symptom, Symptom Clusters, Latent Growth Mixture Model, Root Cause Analysis, Psychological Nursing

摘要：

目的 探讨辅助生殖技术（assisted reproductive technology，ART）受孕孕妇心理症状群变化轨迹及潜在类别的影响因素，为其妊娠期心理健康管理提供理论依据。方法 采用便利抽样法，选取2023年8月—2024年4月在南京市某三级甲等医院产科门诊产检的205例ART受孕孕妇作为调查对象。在妊娠10~14周，发放一般资料调查表、症状自评量表、痛苦自我表露指数量表和积极心理资本问卷，收集基线资料；在妊娠22~26、34~38周发放症状自评量表，收集随访资料。运用探索性因子分析提取症状群，使用潜类别增长混合模型识别心理症状群的变化轨迹，采用多元Logistic回归分析不同轨迹类别的影响因素。结果 最终纳入180例调查对象。探索性因子分析在3个时间点分别提取出5、4、5个症状群。共识别出3个ART受孕孕妇心理症状群变化轨迹类别，分别为低水平-缓慢改善组（28.89%）、高水平-显著加重组（6.11%）和中水平-缓慢加重组（65.00%）。Logistic回归分析结果显示，不孕持续时间、ART治疗次数、文化程度、痛苦自我表露水平和积极心理资本水平是ART受孕孕妇心理症状群变化轨迹潜在类别的影响因素（均P<0.05）。结论 ART受孕孕妇心理症状群变化轨迹存在3个潜在类别，医护人员可根据相关影响因素制订具有针对性的干预措施，实施全面高效的症状管理。

关键词: 辅助生殖技术, 心理症状, 症状群, 潜类别增长混合模型, 影响因素分析, 心理护理