The purpose of this study was to explore correlations among constitution, stress, and discomfort symptoms during the first trimester of pregnancy. We adopted a descriptive and correlational research design and collected data from 261 pregnant women during their first trimester in southern Taiwan using structured questionnaires. Results showed that (1) stress was significantly and positively correlated with Yang-Xu, Yin-Xu, and Tan-Shi-Yu-Zhi constitutions, respectively; (2) Yin-Xu and Tan-Shi-Yu-Zhi constitutions had significant correlations with all symptoms of discomfort, while Yang-Xu had significant correlations with all symptoms of discomfort except for “running nose”; (3) Tan-Shi-Yu-Zhi constitution and stress were two indicators for “fatigue”; Tan-Shi-Yu-Zhi was the indicator for “nausea”; Yang-Xu and Yin-Xu were indicators for “frequent urination.” Our findings also indicate that stress level affects constitutional changes and that stress and constitutional change affect the incidence of discomfort. This research can help healthcare professionals observe these discomforts and provide individualized care for pregnant women, to nurture pregnant women into neutral-type constitution, minimize their levels of discomfort, and promote the health of the fetus and the mother.
People typically fault an individual’s constitution for physical illness. Is constitution changeable? If so, when will it change? These issues have been widely discussed. Wang [
Menstruation, pregnancy, labor, and breastfeeding are female-specific physiological phenomena. From the perspective of traditional Chinese medicine (TCM), for females, “liver” is the fundamental of innate endowment and yin-blood represents the body; “spleen” is the fundamental of acquired constitution and the source of qi, where blood is generated. Therefore, menstruation, pregnancy, labor, and breastfeeding all depend on coordination among the liver, spleen, and kidney. This coordination provides sufficient essences and blood as well as activated yang qi [
From a genetic perspective, constitution represents the characteristics of the individual, which develop gradually, influenced by slow and latent environmental factors during growth, development, and aging. Throughout these processes, constitution remains relatively stable and evolves through variable stages of development. Hence, constitution is not constantly unchangeable; it changes gradually on the basis of genetics, influenced by growth, environment, nutrition, and lifestyle.
Formation of the constitution is greatly influenced by age, environment, and lifestyle. Tian Nian of Ling Shu (Miraculous Pivot) states that “at the age of 20, blood and qi are exuberant; at the age of 30, the five zang-organs localized; at the age of 40, all five zang-organs, six fu-organs, and the 12 regular meridians are merged strongly with great exuberance and interstices but start to decline,” which explains why a body has its own specific physical situations including the exuberance or debilitation of qi, blood, zang-organs, and fu-organs with increasing age [
In females, blood is fundamental, and work is accomplished by the qi, especially by the spleen-stomach qi. Sufficient qi and blood are essential for pregnancy and labor [
Pregnant women encounter internal and external changes as well as physiological and psychological symptoms due to hormonal changes. Common symptoms of discomfort during the first trimester are nausea, vomiting [
In addition, essence-spirit and mood are external expressions of zang-organs, fu-organs, qi, and blood. Inappropriate essence-spirit and mood (e.g., stress and emotional tension) affect the qi movement of zang-organs and fu-organs and obstruct the qi and blood movement, which will affect the constitution. The emotional effects observed most frequently include joy, anger, anxiety, desire, sorrow, fear, and fright. When one feels stressed, one experiences anxiety and desire. Yin Yang Ying Xiang Da Lun in SuWen points out that “anxiety impairs lungs; desire impairs spleen.” Anxiety causes qi depression, resulting in breathing problems and distension discomfort in chests; desire causes qi stagnation, resulting in poor appetite and fatigue. Ben Cang of Ling Shu states that “mood harmony makes concentrated spirit by which regret and anger will not be aroused, and five zang-organs will not be affected by pathogens” [
In light of the above literature review, we understand that the congenital constitution of the fetus is determined by the maternal constitution and that varied constitutions at different stages formed through the processes of growth, development, and all types of acquired external factors. Aside from the effects on the fetus, constitution during pregnancy causes various symptoms of discomfort for the mother. Therefore, to prevent the occurrence of pregnancy complications and to preserve a healthy and neutral-type constitution in the fetus, we should understand the constitution tendency of pregnant women and accurately adjust their constitution so as to achieve sufficient qi and blood as well as yin-yang balance to meet the needs of mother and fetus. Wang et al. [
A study framework for correlations among constitution, stress, and discomfort in the first trimester during pregnancy.
The research questions of this study were (1) what are the relationships among constitution, stress, and discomfort in the first trimester during pregnancy? and (2) what are the contributions of the constitution and stress to discomfort in the first trimester during pregnancy?
A descriptive and correlational research design was utilized. Structured questionnaires were used to collect data from a convenience sampling of 261 pregnant women who received prenatal examination from obstetrics and gynecology clinics and district teaching hospitals in southern Taiwan. Inclusion criteria included women aged 21–48, 6–13 gestational weeks, without pregnancy complications and systemic diseases (such as diabetes mellitus, hypertension, systemic lupus erythematosus, and heart disease), Mandarin- or Taiwanese-speaking, and willing to participate in the study. This study was approved by the Institutional Review Board of Kaoshiung Medical University Hospital (KMUH-IRB-960408) and conducted after the informed consents of participants were obtained. All questionnaires were answered anonymously, and each participant had the right to join or drop during the entire study process.
In this study, research instruments, which were developed based on literature review and expert validity, included the demographic data sheet, Traditional Chinese Medical Constitutional Scale (TCMCS), Visual Analogue Scale (VAS) on Stress, and Evaluation List of Uncomfortable Symptoms During the First Trimester of Pregnancy. Demographic data include obstetrics data, age, gravidity, planned pregnancy or not, exercise regularity, and bedtime. TCMCS, developed by Su [
The collected data were analyzed using SPSS 12.0 statistical software. Descriptive statistics were used to describe demographic characteristics. Inferential statistical methods, such as one-way ANOVA,
Participants in this study were aged between 21 and 42, with a mean age of 29.8 ± 3.96; gestational weeks ranged from 6 to 13, with a mean week of 9.16 ± 2.22. Most of the women had no experience of miscarriage (
Demographic characteristics of participants (
Item | % | Item | % | ||
---|---|---|---|---|---|
Gravidity | Workload | ||||
Primigravida | 129 | 49.4 | Mild | 92 | 35.2 |
Multigravida | 132 | 50.5 | Medium or Excessive | 169 | 64.8 |
Planned pregnancy | |||||
Blood type | No | 140 | 53.6 | ||
A | 59 | 22.6 | Yes | 121 | 46.1 |
B | 71 | 27.2 | Poor appetite due to stress during pregnancy | ||
O | 113 | 43.3 | No | 178 | 68.2 |
AB | 18 | 6.9 | Yes | 83 | 31.8 |
Exercises regularly | Bedtime during pregnancy | ||||
No | 204 | 78.2 | Before 11PM | 131 | 50.2 |
Yes | 57 | 21.8 | After 11PM | 130 | 49.8 |
Participants in this study scored between 20 and 56 (
Pearson’s product-moment correlation indicated that stress has significantly positive correlations with Yang-Xu (
Correlations among symptoms of discomfort in the first trimester, constitution, and stress.
Item | Yang-Xu | Yin-Xu | Tan-Shi-Yu-Zhi | Stress |
---|---|---|---|---|
(1) Nausea | .32** | .30** | .36** | .18** |
(2) Vomiting | .22** | .26** | .28** | .11 |
(3) Breast tenderness | .18** | .14* | .15** | .06 |
(4) Frequent urination | .23** | .26** | .24** | .03 |
(5) Fatigue | .43** | .35** | .44** | .29** |
(6) Heavy vaginal discharge | .31** | .27** | .32** | .15* |
(7) Nasal congestion | .21** | .23** | .24** | .05 |
(8) Running nose | .10 | .14* | .17** | .03 |
(9) Dizziness | .39** | .38** | .41** | .30** |
(10) Mood swings | .44** | .37** | .47** | .36** |
Total score of discomfort | .54** | .51** | .59** | .30** |
Number of discomfort | .36** | .41** | .44** | .21** |
*
Based on the above findings, the symptoms of discomfort in the first trimester were correlated with “Yin-Xu score,” “Yang-Xu score,” “Tan-Shi-Yu-Zhi score,” and “stress level.” By using multinomial logistic regression, the significant indicators for the top five symptoms of discomfort—“nausea,” “vomiting,” “frequent urination,” “breast tenderness,” and “heavy vaginal discharge”—were determined. We integrated the variable of stress level (“extremely severe” to “severe”) due to the small sample size and set “none” as the comparison group, performing the same integration for patients who reported “none” or “mild” fatigue, with patients who reported “mild” fatigue serving as the comparison group. With demographic data such as age, years of education, number of miscarriages, BMI, bedtime and blood type under control, the significant factors for symptoms of discomfort were “Yin-Xu score,” “Yang-Xu score,” “Tan-Shi-Yu-Zhi score,” and “stress level” (see Table
Analysis of multinomial logistic regression for the significant indicators of various symptoms of discomfort (
Symptoms of discomfort | Significant indicators | ||
---|---|---|---|
indicator | degrees of freedom | ||
Fatigue | Tan-Shi-Yu-Zhi score | 2 | <.001 |
Stress | 2 | .013 | |
Nausea | Tan-Shi-Yu-Zhi score | 3 | <.001 |
Frequent urination | Yang-Xu score | 3 | .009 |
Yin-Xu score | 3 | .002 | |
Breast tenderness | Yang-Xu score | 3 | .025 |
Heavy vaginal discharge | Yang-Xu score | 2 | <.001 |
Multinomial logistic regression of effects of significant indicators on symptoms of discomfort (
Discomfort (outcome variable) | Explanatory variable | Degrees of freedom | OR | 95% CI | |
---|---|---|---|---|---|
Tan-Shi-Yu-Zhi | |||||
Moderate versus mild | 1 | <.001 | 1.18 | (1.10, 1.27) | |
Severe versus mild | 1 | <.001 | 1.30 | (1.20, 1.41) | |
Stress | |||||
Moderate versus mild | 1 | .17 | 1.09 | (.96, 1.23) | |
Severe versus mild | 1 | <.001 | 1.23 | (1.07, 1.42) | |
Tan-Shi-Yu-Zhi | |||||
Mild versus none | 1 | .82 | 1.01 | (.93, 1.09) | |
Moderate versus none | 1 | <.001 | 1.16 | (1.06, 1.26) | |
Severe versus none | 1 | <.001 | 1.16 | (1.06, 1.27) | |
Yang-Xu | |||||
Mild versus none | 1 | <.001 | .88 | (.82, .96) | |
Moderate versus none | 1 | .34 | .92 | (.85, .96) | |
Severe versus none | 1 | .47 | .97 | (.88, 1.06) | |
Yin-Xu | |||||
Mild versus none | 1 | <.001 | 1.20 | (1.06, 1.34) | |
Moderate versus none | 1 | <.001 | 1.24 | (1.10, 1.39) | |
Severe versus none | 1 | .02 | 1.18 | (1.03, 1.36) | |
Yang-Xu | |||||
Mild versus none | 1 | .48 | .98 | (.94, 1.03) | |
Moderate versus none | 1 | .27 | 1.03 | (.98, 1.08) | |
Severe versus none | 1 | .14 | 1.04 | (.99, 1.11) | |
Yang-Xu | |||||
Mild versus none | 1 | .06 | 1.05 | (.99, 1.11) | |
Moderate versus none | 1 | <.001 | 1.12 | (1.06, 1.18) |
The findings of this study are the very first understanding of the relationships among constitution, stress, and discomfort symptoms for pregnant women in the first trimester. We found that the significant indicators for the top five symptoms of discomfort include “stress level,” “Yang-Xu score,” “Yin-Xu score,” and “Tan-Shi-Yu-Zhi score.” The results further indicate that “Tan-Shi-Yu-Zhi” and “stress” were the two indicators for fatigue, “Tan-Shi-Yu-Zhi” was the indicator for nausea, “Yang-Xu” and “Yin-Xu” were the two indicators for frequent urination; and “Yang-Xu” was the indicator for heavy vaginal discharge.
This research also suggests that the increase in frequent urination, fatigue, and vaginal discharge has a significantly positive correlation with Yang-Xu and Yin-Xu, which is consistent with the results of Lo and Lo [
Our findings suggest that fatigue has significant and positive correlation with the constitution of Yang-Xu, Yin-Xu, and Tan-Shi-Yu-Zhi, which is consistent with the view of Chen and Zeng [
Our research has shown that there are two emotion-related symptoms, “poor appetite due to stress during pregnancy” and “stress levels”, significantly and positively correlated with Yang-Xu, Yin-Xu, and Tan-Shi-Yu-Zhi; the higher the stress level, the greater the tendency to these three constitutions. The results are in agreement with many previous statements. For example, TCM believes qi and blood are the foundation of essence-spirit and mood, so disharmonious essence-spirit and mood will disturb qi movement in zang-organs and fu-organs and might cause “six depressions”: stagnation of qi, blood, damp, fire, phlegm, and food [
Our findings indicate that the top five symptoms of discomfort during the first trimester of pregnancy are fatigue, nausea, frequent urination, breast tenderness, and heavy vaginal discharge, which are partially consistent with the findings of Cheng [
This research examines the correlations among constitution, demographic characteristics, stress, and discomfort experienced by women during their first trimester of pregnancy. The findings of this study suggest that stress is significantly positively correlated with Yang-Xu, Yin-Xu, and Tan-Shi-Yu-Zhi; total scores and the number of discomfort symptoms during pregnancy are significantly positively correlated with pregnancy constitution. Among those, “frequent urination,” “fatigue,” “heavy vaginal discharge,” “nausea,” “vomiting”, “mood swings,” “nasal congestion,” “dizziness,” and “breast tenderness” are significantly positively correlated with Yin-Xu, Yang-Xu, and Tan-Shi-Yu-Zhi; “running nose” is significantly positively correlated with Yin-Xu and Tan-Shi-Yu-Zhi. These findings indicate that constitution and discomfort symptoms during the first trimester of pregnancy are closely related. This research supports the effect of stress levels on constitutional changes and indicates that appropriate emotional management and regular and healthy bedtime schedules are required to reduce the development of Xu constitution during pregnancy. Healthcare professionals should not only observe the discomfort symptoms of pregnant women but also provide individualized care at the proper time to help pregnant women develop a neutral-type constitution to enhance their comfort during pregnancy and promote the health of fetus and mother.
In addition, the majority of Taiwanese believe that TCM principles are more natural; however, the perinatal care typically provided is dictated by the tenets of Western medicine. The use of the TCM constitutional scale can help pregnant women understand their own constitution and can assist healthcare professionals in providing individualized care and dietary education. The limitation of this cross-sectional research is that it only examines the pregnant women recruited from southern Taiwan. Prenatal and postnatal constitutions of women may be changeable. However, the north-south regional disparity may be a key factor in these constitution issues. Hence, future research could adopt a longitudinal study to examine women’s constitution during the perinatal period among patients from the north, central, and south regions of Taiwan so as to obtain more comprehensive evidence-based information. Another limitation is that we only make the number of primigravida or multigravida among 261 pregnant women clear, but not include the number of primipara or multipara. Since the childbirth may be also influenced to the formation of constitution, future research should include the number of primipara or multipara to provide more suitable evidence-based data.
This study was funded by the National Science Council of Taiwan (Grants NSC 98-2314-B-037-056).