A Nomogram Predicting the Risk of Anxiety in Third-Trimester pregnancy in Pregnant Women with CTDs

Shu Xu,1,* Xiuli Zhong,1,* Xingfeng Cai,1,* Jiawen Wu,2 Hanxiao Wang,2 Shiwen Ni,2 Mei Yang,2 Chen Dong,2 Zhifeng Gu3 1School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, People’s Republic of China; 2Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China; 3Department of Rheumatology and Immunology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chen Dong, Research Center of Clinical Medicine, Research Center of Nursing, Research Center of Clinical Immunology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China, Email [email protected] Zhifeng Gu, Department of Rheumatology, Research Center of Clinical Medicine, Research Center of Nursing, Research Center of Clinical Immunology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China, Tel +86-13706291941, Email [email protected]: Connective tissue diseases (CTDs) is a group of autoimmune diseases that damage multiple systems and can cause anxiety in pregnant women. The aim of this study was to identify risk factors of anxiety during third-trimester pregnancy among CTDs patients and to develop a predictive model to improve clinical outcomes.Patients and Methods: A total of 226 pregnant women with CTDs and 226 normal pregnant women were enrolled in this study during third-trimester pregnancy. This study analyzed risk factors for late pregnancy anxiety in pregnant women with CTDs using binary logistic regression. The probability of anxiety occurrence is predicted by nomogram and further validated by decision curve analysis (DCA), receiver operating characteristic curve (ROC), calibration curve.Results: Anxiety levels were found to be significantly higher in pregnant women with CTDs compared to the control group (4.64± 2.92 VS 3.97± 2.44, P = 0.008). These results suggest that anxiety plays a critical role during the third trimester of pregnancy in this particular population. A total of 33 pregnant women with CTDs (14.6%) reported anxiety in third-trimester pregnancy. Risk factors associated with anxiety in third-trimester pregnancy include sleep disturbances (OR=4.226, 95CI% = 1.508– 11.843), pregnancy stress (OR=1.121, 95CI% = 1.069– 1.175) and family dysfunction (OR = 4.710, 95CI% =1.004– 22.184).Conclusion: The nomogram has clinical utility and robustly predicts the associated anxiety model. During third-trimester pregnancy, sleep disturbances, pregnancy stress, and family dysfunction increase the risk of anxiety in pregnant women with CTDs, which can result in an increased likelihood of emergency cesarean sections and more postpartum blood loss at 2 hours.Keywords: connective tissue diseases, adverse postnatal outcomes, anxiety, nomogram