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A moderated mediation model of perceived stress, negative emotions and mindfulness on fertility quality of life in women with recurrent pregnancy loss

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Abstract

Purpose

This study aimed to investigate the level of fertility related quality of life (FertiQoL) in women with recurrent pregnancy loss (RPL), and to further examine moderated mediation effects of dispositional mindfulness and negative emotions on the relationship between perceived stress and FertiQoL.

Methods

A cross-sectional study was conducted with 262 participants recruited from the infertility outpatient clinics. A self-administered, structured questionnaire including the Simplified Chinese version of FertiQoL tool, the Perceived Stress Scale-10 (PSS-10), the Chinese Version of the Hospital Anxiety and Depression Scale (HADS), and the Mindfulness Attention Awareness Scale (MAAS) was used to collect information in this research. The mediation model and moderated mediation model were conducted using the PROCESS macro for SPSS.

Results

The mean score of Core FertiQoL was 64.59 (SD = 14.76) among women with RPL. Mediation analysis revealed that the association between perceived stress and FertiQoL was partially mediated by negative emotions (indirect effect = − 0.194 for anxiety, and − 0.151 for depression, all P < 0.001). Moderated mediation analysis indicated that the indirect effects of perceived stress on FertiQoL through negative emotions were significantly moderated by dispositional mindfulness. Specifically, the indirect effects of perceived stress on FertiQoL through negative emotions decreased were significant as dispositional mindfulness levels increased.

Conclusion

Overall, women with RPL experienced poor FertiQoL. The Moderated mediation model provides a better understanding of how perceived stress, negative emotions and dispositional mindfulness work together to affect FertiQoL. Interventions aiming to improve FertiQoL in women with RPL should consider targeting these aspects.

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Acknowledgements

This work was supported by grants from the Shandong medical and health science and technology development plan (2017WS301). We are thankful for the generous contributions of the research participants and the staffs who assisted with data collection during the study.

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  1. Guopeng Li and Zhenhua Jiang have contributed equally to this work.

Authors and Affiliations

  1. Center for Reproductive Medicine, Shandong University, Jingliu Road, Shizhong District, Jinan, 250000, Shandong, People’s Republic of China

    Guopeng Li, Zhenhua Jiang, Xue Han, Xue Shang, Wanli Tian, Xiaofei Kang & Mei Fang

  2. Center for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jingliu Road, Shizhong District, Jinan, 250000, Shandong, People’s Republic of China

    Mei Fang

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  1. Guopeng Li
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Contributions

All authors contributed to the study conception and design. GL and ZJ analyzed and interpreted data and drafted the article; GL contributed to data interpretation and critical review; XH, ZJ and XS were responsible for the collection of data and literature review; WT and XK were in charge for literature review; FM was in charge for study design and essential help.

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Correspondence to Mei Fang.

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Li, G., Jiang, Z., Han, X. et al. A moderated mediation model of perceived stress, negative emotions and mindfulness on fertility quality of life in women with recurrent pregnancy loss. Qual Life Res 29, 1775–1787 (2020). https://doi.org/10.1007/s11136-020-02460-2

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