Core Symptoms and Candidate Targets for Symptom Management in Late Pregnancy: A Network Analysis

Women in late pregnancy experience multiple co-occurring physical and psychological symptoms that may affect daily functioning and well-being. However, conventional approaches are limited in identifying priority intervention targets within complex symptom patterns. This study aimed to identify core symptoms and potential targets for symptom management using a network-based approach.

A cross-sectional study was conducted among 444 women in late pregnancy recruited by convenience sampling from a maternal and child health hospital and a tertiary general hospital. Data were collected using a general information questionnaire and a Symptom Assessment Scale for Women in Late Pregnancy, which demonstrated good content validity and internal consistency. Symptom clusters were identified using exploratory factor analysis with principal component extraction, and a covariate-adjusted symptom network was constructed to explore inter-symptom relationships. Computer-simulated interventions were performed to examine the potential impact of symptom alleviation and aggravation within the network.

Six symptom clusters were identified: sleep and physical discomfort, cardiopulmonary load-related, emotional, gastrointestinal, uterine activity-related, and limb/skin clusters. After controlling for covariates, the cluster-specific core symptoms were fatigue (strength = 0.93), chest tightness (strength = 1.18), anxiety (strength = 1.15), nausea (strength = 0.70), abdominal tightness (strength = 1.26), and numbness or tingling in the hands, feet, or legs (strength = -0.11). Simulation analyses suggested that, in the alleviation simulations, shortness of breath/dyspnoea, fatigue, and chest tightness were associated with the largest simulated reductions in overall symptom burden. In the aggravation simulations, loss of appetite, nausea, and anxiety showed the largest simulated increases in overall symptom burden.

This study identified key symptoms and candidate symptom targets within interconnected symptom networks in late pregnancy. The findings may provide exploratory insights for multidisciplinary healthcare professionals, including midwives and obstetricians, to better prioritise and individualise symptom assessment and management in antenatal care.