{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T17:35:19Z","timestamp":1782754519576,"version":"3.54.5"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T00:00:00Z","timestamp":1623369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014804","name":"Mackay Medical College","doi-asserted-by":"publisher","award":["1041A02"],"award-info":[{"award-number":["1041A02"]}],"id":[{"id":"10.13039\/501100014804","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004861","name":"Mackay Memorial Hospital","doi-asserted-by":"publisher","award":["MMH-MM-10712"],"award-info":[{"award-number":["MMH-MM-10712"]}],"id":[{"id":"10.13039\/501100004861","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>During pregnancy, a woman\u2019s enlarged uterus and the developing fetus lead to symptom distress; in turn, physical and psychological aspects of symptom distress are often associated with adverse prenatal and birth outcomes. This study aimed to identify the trends in the trajectory of these symptoms. This longitudinal study recruited 95 pregnant women, with a mean age of 32 years, from the prenatal wards of two teaching hospitals in northern Taiwan. Symptom distress was measured by a 22-item scale related to pregnancy-induced symptoms. The follow-up measurements began during the first trimester and were taken every two to four weeks until childbirth. More than half of the pregnant women experienced symptom distress manifested in a pattern depicted to be \u201cDecreased then Increased\u201d (56.8%). Other noticeable patterns were \u201cContinuously Increased\u201d (28.4%), \u201cIncreased then Decreased\u201d (10.5%) and \u201cContinuously Decreased\u201d (4.2%), respectively. It is worth noting that most pregnant women recorded a transit and increase in their symptom distress, revealed by their total scores, at the second trimester (mean 22.02 weeks) of pregnancy. The participants\u2019 major pregnancy-related distress symptoms were physical and included fatigue, frequent urination, lower back pain, and difficulty sleeping. The mean scores for individual symptoms ranged from 2.32 to 3.61 and were below the \u201cmoderately distressful\u201d level. This study provides evidence that could be used to predict women\u2019s pregnancy-related symptom distress and help healthcare providers implement timely interventions to improve prenatal care.<\/jats:p>","DOI":"10.3390\/ijerph18126333","type":"journal-article","created":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T12:44:37Z","timestamp":1623415477000},"page":"6333","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Identifying Patterns of Symptom Distress in Pregnant Women: A Pilot Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1965-1909","authenticated-orcid":false,"given":"Ching-Fang","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Nursing, Mackay Medical College, New Taipei City 25245, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4305-686X","authenticated-orcid":false,"given":"Fur-Hsing","family":"Wen","sequence":"additional","affiliation":[{"name":"Department of International Business, Soochow University, Taipei City 100006, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1522-7799","authenticated-orcid":false,"given":"Yvonne","family":"Hsiung","sequence":"additional","affiliation":[{"name":"Department of Nursing, Mackay Medical College, New Taipei City 25245, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Pei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei City 104217, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Wei","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Fu Jen Catholic University Hospital, New Taipei City 24352, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7972-3495","authenticated-orcid":false,"given":"Hung-Hui","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Nursing, College of Medicine, National Taiwan University, Taipei City 10051, Taiwan"},{"name":"Department of Nursing, National Taiwan University Hospital, Taipei City 10002, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.jogn.2017.03.007","article-title":"Symptom experience in late pregnancy","volume":"46","author":"Beebe","year":"2017","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"bjgpopen19X101674","DOI":"10.3399\/bjgpopen19X101674","article-title":"Examining to what extent pregnancy-related physical symptoms worry women in the first trimester of pregnancy: A cross-sectional study in general practice","volume":"3","author":"Lutterodt","year":"2019","journal-title":"BJGP Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/scs.12718","article-title":"Pregnancy complications, sick leave and service needs of women who experience perinatal distress, weak social support and dissatisfaction in their partner relationships","volume":"34","author":"Jonsdottir","year":"2020","journal-title":"Scand. J. Caring Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e180725","DOI":"10.1001\/jamanetworkopen.2018.0725","article-title":"Prevalence of prenatal depression symptoms among 2 Generations of pregnant mothers: The Avon longitudinal study of parents and children","volume":"1","author":"Pearson","year":"2018","journal-title":"JAMA Netw. Open"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.jpeds.2018.12.050","article-title":"Prenatal maternal psychological distress and offspring risk for recurrent respiratory infections","volume":"208","author":"Korhonen","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Vollrath, M.E., Sengpiel, V., Landolt, M.A., Jacobsson, B., and Latal, B. (2016). Is maternal trait anxiety a risk factor for late preterm and early term deliveries?. BMC Pregnancy Childbirth, 16.","DOI":"10.1186\/s12884-016-1070-1"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"21","DOI":"10.4103\/ijpvm.IJPVM_300_17","article-title":"Effect of self-care before and during pregnancy to prevention and control preeclampsia in high-risk women","volume":"10","author":"Rasouli","year":"2019","journal-title":"Int. J. Prev. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2027","DOI":"10.1080\/14767058.2018.1536739","article-title":"Maternal severe stressful life events and risk of abnormal vaginal bleeding among urban Chinese pregnant women","volume":"33","author":"Zheng","year":"2020","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s00737-018-0903-5","article-title":"Sleeping problems during pregnancy-a risk factor for postnatal depressiveness","volume":"22","author":"Paunio","year":"2019","journal-title":"Arch. Womens Ment. Health"},{"key":"ref_10","first-page":"39","article-title":"Anxiety during pregnancy and postpartum: Course, predictors and comorbidity with postpartum depression","volume":"57","author":"Tadinac","year":"2018","journal-title":"Acta Clin. Croat."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1002\/nur.21935","article-title":"Identifying clusters from multidimensional symptom trajectories in postpartum women","volume":"42","author":"Paul","year":"2019","journal-title":"Res. Nurs. Health"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Bai, G., Korfage, I.J., Groen, E.H., Jaddoe, V.W., Mautner, E., and Raat, H. (2016). Associations between Nausea, Vomiting, Fatigue and Health-Related Quality of Life of Women in Early Pregnancy: The Generation R Study. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0166133"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/jnu.12456","article-title":"Strengthening inter- and intraprofessional collaborations to advance biobehavioral symptom science","volume":"51","author":"Starkweather","year":"2019","journal-title":"J. Nurs. Scholarsh."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1177\/1099800413506036","article-title":"Effects of professional support on nausea, vomiting, and quality of life during early pregnancy","volume":"16","author":"Liu","year":"2014","journal-title":"Biol. Res. Nurs."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"840923","DOI":"10.1155\/2014\/840923","article-title":"Guided imagery for stress and symptom management in pregnant African American women","volume":"2014","author":"Jallo","year":"2014","journal-title":"Evid. Based Complement. Alternat. Med."},{"key":"ref_16","unstructured":"(2021, April 06). Health Promotion Administration. Maternal Health Booklet. c2021, Available online: https:\/\/www.gender.ey.gov.tw\/gecdb\/Stat_Statistics_DetailData.aspx?sn=UNgbUqD746EaB%2fcBxzuqGw%3d%3d&d=194q2o4%2botzoYO%2b8OAMYew%3d%3d\u201dhttps:\/\/www.hpa.gov.tw\/File\/Attach\/7667\/File_7162.pdf."},{"key":"ref_17","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Lawrence Erlbaum Associates. [2nd ed.]."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"70","DOI":"10.2307\/1165262","article-title":"Sample size estimation for longitudinal designs with attrition","volume":"24","author":"Hedeker","year":"1999","journal-title":"J. Educ. Behav. Stat."},{"key":"ref_19","first-page":"206","article-title":"Symptom distress for women in different trimesters","volume":"29","author":"Lee","year":"2009","journal-title":"J. Orient. Inst. Tech."},{"key":"ref_20","unstructured":"Chien, S.Y. (2013). Comparison of Prenatal Stress, Symptom Distress, Social Support and Quality of Life Between Advanced-Age and Appropriate Reproductive Age Pregnant Women during Third Trimester. [Master\u2019s Thesis, Taipei University of Nursing and Health]."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e4794","DOI":"10.7717\/peerj.4794","article-title":"A brief introduction to mixed effects modelling and multi-model inference in ecology","volume":"6","author":"Harrison","year":"2018","journal-title":"PeerJ"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1177\/0962280207088026","article-title":"Optimal designs for empirical bayes estimators of individual linear and quadratic growth curves in linear mixed models","volume":"18","author":"Candel","year":"2009","journal-title":"Stat. Methods Med. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"169","DOI":"10.3102\/10769986028002169","article-title":"Performance of empirical bayes estimators of level-2 random parameters in multilevel analysis: A Monte Carlo study for longitudinal designs","volume":"28","author":"Candel","year":"2003","journal-title":"J. Educ. Behav. Stat."},{"key":"ref_24","unstructured":"Mattson, S., and Smith, J.E. (2018). Fetal and placental Development and Functioning. Core Curriculum for Maternal-Newborn Nursing, Mosby. [5th ed.]."},{"key":"ref_25","unstructured":"Cunningham, F.G. (2018). Maternal physiology. Williams Obstetrics, McGraw-Hill Education\/Medical. [25th ed.]. Chapter4."},{"key":"ref_26","unstructured":"Lockwood, C.J. (2021). Maternal Adaptations to Pregnancy: Musculoskeletal Changes and Pain, Available online: https:\/\/www.uptodate.com\/contents\/maternal-adaptations-to-pregnancy-musculoskeletal-changes-and-pain."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.nepr.2018.09.003","article-title":"Constructing and applying an exercise counseling model for pregnant women: A preliminary study","volume":"33","author":"Lee","year":"2018","journal-title":"Nurse Educ. Pract."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e12837","DOI":"10.1111\/ijn.12837","article-title":"Effectiveness of individual face-to-face exercise counselling in changing exercise behaviours to relieve symptom distress in pregnant women","volume":"26","author":"Lee","year":"2020","journal-title":"Int. J. Nurs. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1080\/08039488.2019.1579861","article-title":"Physical discomfort in early pregnancy and postpartum depressive symptoms","volume":"73","author":"Ertmann","year":"2019","journal-title":"Nord. J. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1080\/02646838.2019.1578871","article-title":"Pregnancy-specific coping and changes in emotional distress from mid- to late pregnancy","volume":"37","author":"Ibrahim","year":"2019","journal-title":"J. Reprod. Infant. Psychol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.sleep.2020.03.031","article-title":"Insomnia symptoms increase during pregnancy, but no increase in sleepiness\u2014Associations with symptoms of depression and anxiety","volume":"72","author":"Aukia","year":"2020","journal-title":"Sleep Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.jad.2020.02.031","article-title":"Body dissatisfaction and Fat Talk during pregnancy: Predictors of distress","volume":"267","author":"Dryer","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.wombi.2020.01.009","article-title":"Psychological distress in pregnancy and postpartum","volume":"33","author":"Obrochta","year":"2020","journal-title":"Women Birth"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.comppsych.2017.02.002","article-title":"Pregnancy-specific anxiety and its association with background characteristics and health-related behaviors in a low-risk population","volume":"75","author":"Westerneng","year":"2017","journal-title":"Compr. Psychiatry"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"11084","DOI":"10.1038\/s41598-020-67852-3","article-title":"Association of maternal sleep before and during pregnancy with preterm birth and early infant sleep and temperament","volume":"10","author":"Nakahara","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1080\/14767058.2016.1183637","article-title":"Sleep disturbances during pregnancy are associated with cesarean delivery and preterm birth","volume":"30","author":"Li","year":"2017","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/ajo.12714","article-title":"Nausea and vomiting of pregnancy: Effects on quality of life and day-to-day function","volume":"58","author":"Tan","year":"2018","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1097\/JPN.0000000000000078","article-title":"Gastrointestinal distress in pregnancy: Prevalence, assessment, and treatment of 5 common minor discomforts","volume":"29","author":"Zielinski","year":"2015","journal-title":"J. Perinat. Neonatal Nurs."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e17318","DOI":"10.1097\/MD.0000000000017318","article-title":"Effects of exercise therapy for pregnancy-related low back pain and pelvic pain: A protocol for systematic review and meta-analysis","volume":"99","author":"Hu","year":"2020","journal-title":"Medicine"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/nhs.12149","article-title":"Survey of trend and factors in perinatal maternal fatigue","volume":"17","author":"Cheng","year":"2015","journal-title":"Nurs. Health Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s00737-012-0322-y","article-title":"Premenstrual symptoms are associated with psychological and physical symptoms in early pregnancy","volume":"16","author":"Winkel","year":"2013","journal-title":"Arch. Womens Ment. Health"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Smith, M.J., and Liehr, P.R. (2018). Theory of symptom management. Middle Range Theory for Nursing, Springer Publishing Co. [4th ed.].","DOI":"10.1891\/9780826159922"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Chen, C.-N., Yu, H.-C., and Chou, A.-K. (2020). Association between Maternal Pre-pregnancy Body Mass Index and Breastfeeding Duration in Taiwan: A Population-Based Cohort Study. Nutrients, 12.","DOI":"10.3390\/nu12082361"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2928","DOI":"10.1038\/s41598-019-39167-5","article-title":"Investigating the relationship between district-level socioeconomic status and individual obesity in Taiwanese adolescents: A large-scale cross-sectional analysis","volume":"9","author":"Ni","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4926702","DOI":"10.1155\/2020\/4926702","article-title":"Mental Health Problems during Pregnancy and the Postpartum Period: A Multicenter Knowledge Assessment Survey among Healthcare Providers","volume":"2020","author":"Patabendige","year":"2020","journal-title":"J. Pregnancy"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1097\/NMD.0000000000001173","article-title":"Psychological distress during pregnancy: Cross-sectional prevalence and associated risk factors in a South African sample","volume":"208","author":"Spedding","year":"2020","journal-title":"J. Nerv. Ment. Dis."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/12\/6333\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:13:16Z","timestamp":1760163196000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/12\/6333"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,11]]},"references-count":46,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["ijerph18126333"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18126333","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,11]]}}}