Happiness among nulliparous women of advanced maternal age (AMA): The mediating role of psychosocial factors

This study examined the association between pregnancy stress and happiness and explored the indirect associations through psychosocial factors (maternal identity, childbirth confidence, marital intimacy, and maternal-fetal attachment) among nulliparous women of advanced maternal age. This analytical cross-sectional study was conducted in South Korea using a web-based convenience sample of 165 nulliparous women aged 35 years or older recruited through the country's largest online community for pregnant women. Data were collected from September to October 2023 through a structured online survey and analyzed using IBM SPSS Statistics Version 25.0 and Hayes' PROCESS Macro model 4. The analysis estimated cross-sectional indirect associations rather than causal mediation. Pregnancy stress showed significant total and direct associations with happiness. Significant indirect associations were observed through maternal identity, childbirth confidence, and marital intimacy, whereas maternal-fetal attachment did not show a significant indirect association. These findings may inform programs aimed at reducing pregnancy stress and strengthening psychosocial resources to support positive pregnancy experiences and psychological well-being among nulliparous women of advanced maternal age.