{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T22:37:49Z","timestamp":1792881469071,"version":"4.5.0"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"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. Psychiatry"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aims to explore the relationship between pregnancy stress (PS) and antenatal depression (AD) among Chinese pregnant women and to investigate whether maternal health literacy (MHL) and social support (SS) mediate the relationship between PS and AD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This cross-sectional study utilized a two-stage sampling approach, combining stratified random cluster sampling in the first stage with convenience sampling in the second stage, to enroll 1,391 pregnant women attending prenatal care at six hospitals in Chongqing between September 2023 and February 2024. Data were collected using structured scales, including general information questionnaire, Edinburgh Postnatal Depression Scale(EPDS), Pregnancy Stress Scale(PSS), Multidimensional Scale of Perceived Social Support(MSPSS) and Maternal health literacy questionnaire. We utilized Amos 22.0 to establish a structural equation model(SEM).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>443 participants (31.85%) reported symptoms of depression, and 382 participants (27.46%) had moderate or above stress; in contrast, only 82 participants (5.90%) reached the level of MHL. Spearman correlation analysis revealed that all the variables were significantly correlated with AD (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.01). SEM revealed several effects on AD, including PS (<jats:italic>\u03b2<\/jats:italic> = 0.470, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.01), SS (<jats:italic>\u03b2<\/jats:italic> = -0.257, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.01) and MHL (<jats:italic>\u03b2<\/jats:italic> = -0.095, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.01), all of which were associated with higher depression scores. SS and MHL mediated the link between PS and AD. MHL and SS exerted a negative influence on PS (<jats:italic>\u03b2<\/jats:italic> =\u22120.236, -0.289; <jats:italic>p<\/jats:italic> &amp;lt; 0.01). There was no evidence of a mediating effect of MHL on the relationship between SS and AD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PS, SS and MHL have a direct effect on AD. Moreover, MHL and SS play a mediating role between PS and AD. Health care providers should be aware of the potential threat of PS progressing to AD. Under the guidance of the principles of enhancing MHL and strengthening SS, in the short term, the focus should be on improving the MHL among Chinese population.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1600448","type":"journal-article","created":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T14:48:15Z","timestamp":1750690095000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["The relationship between pregnancy stress and antepartum depression in Chinese pregnant women: the mediating effect of social support and maternal health literacy"],"prefix":"10.3389","volume":"16","author":[{"given":"Ling","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanghui","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengju","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Feng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honghui","family":"Rong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanfen","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enyu","family":"Lei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangxu","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Ren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji-An","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3818","DOI":"10.3390\/ijerph20053818","article-title":"Latent trajectories and risk factors of prenatal stress, anxiety, and depression in southwestern China-A longitudinal study","volume":"20","author":"Gao","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2018.06.014","article-title":"The role of social support in family socio-economic disparities in depressive symptoms during early pregnancy: Evidence from a Chinese birth cohort","volume":"238","author":"Wei","year":"2018","journal-title":"J Affect Disord"},{"key":"B3","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1186\/s12889-020-8293-9","article-title":"Global burden of antenatal depression and its association with adverse birth outcomes: an umbrella review","volume":"20","author":"Dadi","year":"2020","journal-title":"BMC Public Health"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-016-1989-x","article-title":"Racial\/ethnic disparities in antenatal depression in the United States: A systematic review","volume":"20","author":"Mukherjee","year":"2016","journal-title":"Maternal Child Health J"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.27652\/d.cnki.gzyku.2023.000807","article-title":"Prenatal anxiety and depression symptoms and influencing factors of pregnant women in Shenyang during Omicron virus epidemic","author":"Ru","year":"2023","journal-title":"Master\u2019s thesisChina Med University,Liaoning"},{"key":"B6","article-title":"Depression during pregnancy: rates, risks and consequences\u2013Motherisk Update 2008","volume":"16","author":"Marcus","year":"2009","journal-title":"Can J Clin Pharmacol = J canadien pharmacologie clinique"},{"key":"B7","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1097\/01.AOG.0000116689.75396.5f","article-title":"Prevalence of depression during pregnancy: systematic review","volume":"103","author":"Bennett","year":"2004","journal-title":"Obstetrics gynecology"},{"key":"B8","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.jad.2022.08.076","article-title":"Path analysis of influencing factors for prenatal depressive symptoms in pregnant women","volume":"317","author":"Jiang","year":"2022","journal-title":"J Affect Disord"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.infbeh.2009.10.004","article-title":"Comorbid depression and anxiety effects on pregnancy and neonatal outcome","volume":"33","author":"Field","year":"2010","journal-title":"Infant Behav Dev"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2011.08.035","article-title":"Postpartum depression predicts offspring mental health problems in adolescence independently of parental lifetime psychopathology","volume":"136","author":"Verbeek","year":"2012","journal-title":"J Affect Disord"},{"key":"B11","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.jad.2015.11.014","article-title":"Identifying the women at risk of antenatal anxiety and depression: A systematic review","volume":"191","author":"Biaggi","year":"2016","journal-title":"J Affect Disord"},{"key":"B12","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/s00737-018-0880-8","article-title":"Postnatal depressive symptoms in women with and without antenatal depressive symptoms: results from a prospective cohort study","volume":"22","author":"Pampaka","year":"2019","journal-title":"Arch women\u2019s Ment Health"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2023.103871","article-title":"Prospective analysis of factors associated with perinatal depression","volume":"128","author":"Al-Abri","year":"2024","journal-title":"Midwifery"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10389-022-01806-z","article-title":"Association between pregnant specific stress and depressive symptoms in the late pregnancy of Chinese women: the moderate role of family relationship and leisure hobbies","volume":"28","author":"Zhao","year":"2022","journal-title":"J Public Health"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.5603\/GP.a2018.0017","article-title":"The phenomenon of pregnancy - a psychological view","volume":"89","author":"Bjelica","year":"2018","journal-title":"Ginekologia polska"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2021.2001044","article-title":"Fear, anxiety and depression among pregnant women during COVID-19 pandemic: impacts of healthy eating behaviour and health literacy","volume":"53","author":"Luong","year":"2021","journal-title":"Ann Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1186\/s12888-024-05604-7","article-title":"Factors associated with stress among pregnant women with a second child in Hunan province under China\u2019s two-child policy: a mixed-method study","volume":"24","author":"Zhang","year":"2024","journal-title":"BMC Psychiatry"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-010-0732-2","article-title":"Factors associated with perceived stress and stressful life events in pregnant women: findings from the Canadian Maternity Experiences Survey","volume":"16","author":"Kingston","year":"2012","journal-title":"Maternal Child Health J"},{"key":"B19","article-title":"The course of maternal pregnancy-specific stress across pregnancy and effects on primary pregnancy outcomes: a prospective study","author":"Zhang","year":"2017","journal-title":"Master\u2019s thesis Chinese Center Dis Control Prevention Beijing"},{"key":"B20","doi-asserted-by":"publisher","first-page":"4742","DOI":"10.1038\/s41598-024-55355-4","article-title":"Path analysis of influencing factors for maternal antenatal depression in the third trimester","volume":"14","author":"Wang","year":"2024","journal-title":"Sci Rep"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.22088\/cjim.11.2.211","article-title":"Prevalence and factors related to psychiatric symptoms in low risk pregnancy","volume":"11","author":"Faramarzi","year":"2020","journal-title":"Caspian J Internal Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.2307\/2136658","article-title":"Models for the stress-buffering functions of coping resources","volume":"26","author":"Wheaton","year":"1985","journal-title":"J Health Soc behavior"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2024.1330720","article-title":"Social support and mental health: the mediating role of perceived stress","volume":"15","author":"Acoba","year":"2024","journal-title":"Front Psychol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1186\/s12884-020-02859-2","article-title":"Antenatal depression and its potential causal mechanisms among pregnant mothers in Gondar town: application of structural equation model","volume":"20","author":"Dadi","year":"2020","journal-title":"BMC pregnancy childbirth"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.98.2.310","article-title":"Stress, social support, and the buffering hypothesis","volume":"98","author":"Cohen","year":"1985","journal-title":"psychol Bull"},{"key":"B26","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1186\/s12978-021-01209-5","article-title":"The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis","volume":"18","author":"Bedaso","year":"2021","journal-title":"Reprod Health"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.19082\/6027","article-title":"The impact of social capital and social support on the health of female-headed households: a systematic review","volume":"9","author":"Khazaeian","year":"2017","journal-title":"Electronic physician"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1001\/jama.281.6.552","article-title":"Ad hoc committee on health literacy for the council on scientific affairs, american medical association","volume":"281","year":"1999","journal-title":"Jama"},{"key":"B29","doi-asserted-by":"publisher","first-page":"195","DOI":"10.21101\/cejph.a6692","article-title":"Low health literacy and perceived stress in adults: is there a link","volume":"29","author":"Michou","year":"2021","journal-title":"Cent Eur J Public Health"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.4103\/ANT.33-4_112_0063","article-title":"Association between health literacy with stress, anxiety and depression in multiple sclerosis patients: A cross sectional analytical study","volume":"33","author":"Dehghani","year":"2024","journal-title":"Acta neurologica Taiwanica"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.6061\/clinics\/2020\/e1436","article-title":"Health literacy and depression in women with type 2 diabetes mellitus","volume":"75","author":"Hsu","year":"2020","journal-title":"Clinics (Sao Paulo Brazil)"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2016.10.006","article-title":"The mediation effect of health literacy between subjective social status and depressive symptoms in patients with heart failure","volume":"91","author":"Zou","year":"2016","journal-title":"J psychosomatic Res"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnu.2021.09.003","article-title":"Postpartum depression: Mental health literacy of Indian mothers","volume":"35","author":"Poreddi","year":"2021","journal-title":"Arch Psychiatr Nurs"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2015.09.002","article-title":"Women\u05f3s help-seeking behaviours for depressive symptoms during the perinatal period: Socio-demographic and clinical correlates and perceived barriers to seeking professional help","volume":"31","author":"Fonseca","year":"2015","journal-title":"Midwifery"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.150.6.782","article-title":"Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale","volume":"150","author":"Cox","year":"1987","journal-title":"Br J psychiatry: J Ment Sci"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.172.5.433","article-title":"Detecting postnatal depression in Chinese women. Validation of the Chinese version of the Edinburgh Postnatal Depression Scale","volume":"172","author":"Lee","year":"1998","journal-title":"Br J psychiatry: J Ment science"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2022.12.008","article-title":"Association between antenatal depression and adverse perinatal outcomes: a prospective cohort study","volume":"323","author":"Zhang","year":"2023","journal-title":"J Affect Disord"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.7150\/ijms.9.40","article-title":"The simplified Edinburgh Postnatal Depression Scale (EPDS) for antenatal depression: is it a valid measure for pre-screening","volume":"9","author":"Choi","year":"2012","journal-title":"Int J Med Sci"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2010.02.005","article-title":"Validation of the Mainland Chinese version of the Edinburgh Postnatal Depression Scale in Chengdu mothers","volume":"47","author":"Lau","year":"2010","journal-title":"Int J Nurs Stud"},{"key":"B40","article-title":"Stressors associated with pregnancy as perceived by pregnant women during three trimesters","volume":"5","author":"Chen","year":"1989","journal-title":"Gaoxiong yi xue ke xue za zhi = Kaohsiung J Med Sci"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1080\/00223891.1990.9674095","article-title":"Psychometric characteristics of the multidimensional scale of perceived social support","volume":"55","author":"Zimet","year":"1990","journal-title":"J Pers assessment"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05829-8","article-title":"The mediating role of perceived stress on the relationship between perceived social support and self-care ability among Chinese enterostomy patients","volume":"29","author":"Wang","year":"2021","journal-title":"Supportive Care cancer: Off J Multinational Assoc Supportive Care Cancer"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1117332","article-title":"Postpartum depression literacy in Chinese perinatal women: a cross-sectional study","volume":"14","author":"Huang","year":"2023","journal-title":"Front Psychiatry"},{"key":"B44","volume-title":"Study on the status of maternal and infant health literacy and its impact on pregnancy outcomes in Gansu Province. Master Dissertation","author":"Chen","year":"2020"},{"key":"B45","volume-title":"Correlation study of perinatal pregnant women\u2019s health literacy and self-care ability. Master dissertation","author":"Liu","year":"2018"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.603325","article-title":"Health literacy and regional heterogeneities in China: A population-based study","volume":"9","author":"Li","year":"2021","journal-title":"Front Public Health"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-14958-0","article-title":"Investigation of health literacy status and related influencing factors in military health providers of Chinese People\u2019s liberation Army, a cross-sectional study","volume":"23","author":"Rong","year":"2023","journal-title":"BMC Public Health"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.00374","article-title":"Prevalence of prenatal depression among pregnant women and the importance of resilience: A multi-site questionnaire-based survey in mainland China","volume":"11","author":"Zhang","year":"2020","journal-title":"Front Psychiatry"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.4314\/mmj.v33i1.8","article-title":"Prevalence and predictors of depression, anxiety, and stress symptoms among pregnant women during COVID-19-related lockdown in Abakaliki, Nigeria","volume":"33","author":"Nwafor","year":"2021","journal-title":"Malawi Med journal: J Med Assoc Malawi"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.1490","article-title":"Prevalence and associated factors of depression, anxiety, and stress among pregnant women in Herat, Afghanistan: A cross-sectional study","volume":"6","author":"Niazi","year":"2023","journal-title":"Health Sci Rep"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.1067757","article-title":"The relationship between positive psychological qualities and prenatal negative emotion in pregnant women: A path analysis","volume":"13","author":"Tuxunjiang","year":"2022","journal-title":"Front Psychol"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1620\/tjem.245.223","article-title":"Positive Emotion and its Changes during Pregnancy: Adjunct Study of Japan Environment and Children\u2019s Study in Miyagi Prefecture","volume":"245","author":"Nakamura","year":"2018","journal-title":"Tohoku J Exp Med"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2024.1400267","article-title":"The chain mediating effects of resilience and perceived social support in the relationship between perceived stress and depression in patients with COVID-19","volume":"15","author":"Wang","year":"2024","journal-title":"Front Psychol"},{"key":"B54","doi-asserted-by":"publisher","first-page":"31080","DOI":"10.1038\/s41598-024-82187-z","article-title":"Impact of health information seeking behavior and digital health literacy on self-perceived health and depression symptoms among older adults in the United States","volume":"14","author":"Nutakor","year":"2024","journal-title":"Sci Rep"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2022.2101688","article-title":"COVID-19-related fear, stress and depression in school principals: impacts of symptoms like COVID-19, information confusion, health-related activity limitations, working hours, sense of coherence and health literacy","volume":"54","author":"Duong","year":"2022","journal-title":"Ann Med"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1188072","article-title":"Pathway analysis of the impact of health literacy, social support and self-efficacy on self-management behaviors in pregnant women with gestational diabetes mellitus","volume":"11","author":"Tang","year":"2023","journal-title":"Front Public Health"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1416620","article-title":"The mediating effect of e-health literacy on social support and behavioral decision-making on glycemic management in pregnant women with gestational diabetes: a cross-sectional study","volume":"12","author":"Yumei","year":"2024","journal-title":"Front Public Health"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.20043\/j.cnki.MPM.202210478","article-title":"Corelation between the perinatal health literacy and family function of NICU premature mothers","volume":"35","author":"Wang","year":"2019","journal-title":"Chin J Health Educ"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1600448\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T14:48:19Z","timestamp":1750690099000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1600448\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":58,"alternative-id":["10.3389\/fpsyt.2025.1600448"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1600448","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,23]]},"article-number":"1600448"}}