{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T06:51:36Z","timestamp":1781679096055,"version":"3.54.5"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Aim<\/jats:title>\n This study aimed to explore the chain mediating effect and cross-lagged associations between pregnancy-related anxiety and hope in the relationship between family function (FF) and blood glucose management behavioral decision-making (BDM) among patients with gestational diabetes mellitus (GDM). This study also aimed to provide insights into enhancing self-management efficacy and optimizing maternal and infant outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A convenience sample of 245 GDM patients was selected. Surveys were conducted using the Pregnancy-related Anxiety Questionnaire (PAQ), the Herth Hope Index (HHI), the Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Index, and the Blood Glucose Management Decision-Making Behavior Questionnaire at three time points: 24\u201328\u202fweeks of gestation (T1), 32\u202fweeks of gestation (T2), and 36\u201342\u202fweeks of gestation (T3). Statistical analyses included equivalence testing and cross-lagged modeling.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 220 valid questionnaires were collected. Equivalence testing indicated that all variables met the requirements for measurement invariance, ensuring cross-temporal comparability of the tools. Cross-lagged path analysis revealed that T1 family function significantly predicted T2 pregnancy-related anxiety (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.26,\n p<\/jats:italic>\n \u202f&lt;\u202f0.01), T2 hope (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.18,\n p<\/jats:italic>\n \u202f&lt;\u202f0.01), and T2 behavioral decision-making (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.24,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). T1 pregnancy-related anxiety significantly predicted T2 hope (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.11,\n p<\/jats:italic>\n \u202f&lt;\u202f0.01) and T2 behavioral decision-making (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.28,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). T2 family function positively predicted T3 hope (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.18,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), while T2 pregnancy-related anxiety negatively predicted T3 behavioral decision-making (\n \u03b2<\/jats:italic>\n \u202f=\u202f\u22120.25,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001). T2 hope positively predicted T3 behavioral decision-making (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.18,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001), and T2 behavioral decision-making positively predicted T3 family function (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.11,\n p<\/jats:italic>\n \u202f&lt;\u202f0.01). Bootstrap analysis demonstrated significant indirect effects of T2 pregnancy-related anxiety (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.065,\n p<\/jats:italic>\n \u202f&lt;\u202f0.01) and T2 hope (\n \u03b2<\/jats:italic>\n \u202f=\u202f0.032,\n p<\/jats:italic>\n \u202f&lt;\u202f0.01) in the prediction of T3 behavioral decision-making by T1 family function.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Clinical practice should develop family-centered intervention models, assess family function, screen for anxiety, and enhance hope through psychological support and health education to promote positive behavioral decision-making and improve blood glucose control.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1838381","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T05:51:51Z","timestamp":1781675511000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The relationship between family function and behavioral decision-making in patients with gestational diabetes mellitus: a multiple mediation model and cross-lagged analysis of pregnancy-related anxiety and hope"],"prefix":"10.3389","volume":"13","author":[{"given":"Rui","family":"Li","sequence":"first","affiliation":[{"name":"Chronic Disease Management Center, The Second Affiliated Hospital of Xuzhou Medical University","place":["Xuzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Peng","sequence":"additional","affiliation":[{"name":"Chronic Disease Management Center, The Second Affiliated Hospital of Xuzhou Medical University","place":["Xuzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Miao","sequence":"additional","affiliation":[{"name":"Chronic Disease Management Center, The Second Affiliated Hospital of Xuzhou Medical University","place":["Xuzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinhui","family":"Yu","sequence":"additional","affiliation":[{"name":"Chronic Disease Management Center, The Second Affiliated Hospital of Xuzhou Medical University","place":["Xuzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Nursing, The Second Affiliated Hospital of Xuzhou Medical University","place":["Xuzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"4653","DOI":"10.2147\/JMDH.S529029","article-title":"Factors influencing adherence to dietary interventions among patients with gestational diabetes mellitus in China: a qualitative study based on the com-b model","volume":"18","author":"Jia","year":"2025","journal-title":"J 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