A moderated mediation model of perceived stress, negative emotions and mindfulness on fertility quality of life in women with recurrent pregnancy loss

Qual Life Res. 2020 Jul;29(7):1775-1787. doi: 10.1007/s11136-020-02460-2. Epub 2020 Feb 28.


Purpose: This study aimed to investigate the level of fertility related quality of life (FertiQoL) in women with recurrent pregnancy loss (RPL), and to further examine moderated mediation effects of dispositional mindfulness and negative emotions on the relationship between perceived stress and FertiQoL.

Methods: A cross-sectional study was conducted with 262 participants recruited from the infertility outpatient clinics. A self-administered, structured questionnaire including the Simplified Chinese version of FertiQoL tool, the Perceived Stress Scale-10 (PSS-10), the Chinese Version of the Hospital Anxiety and Depression Scale (HADS), and the Mindfulness Attention Awareness Scale (MAAS) was used to collect information in this research. The mediation model and moderated mediation model were conducted using the PROCESS macro for SPSS.

Results: The mean score of Core FertiQoL was 64.59 (SD = 14.76) among women with RPL. Mediation analysis revealed that the association between perceived stress and FertiQoL was partially mediated by negative emotions (indirect effect = - 0.194 for anxiety, and - 0.151 for depression, all P < 0.001). Moderated mediation analysis indicated that the indirect effects of perceived stress on FertiQoL through negative emotions were significantly moderated by dispositional mindfulness. Specifically, the indirect effects of perceived stress on FertiQoL through negative emotions decreased were significant as dispositional mindfulness levels increased.

Conclusion: Overall, women with RPL experienced poor FertiQoL. The Moderated mediation model provides a better understanding of how perceived stress, negative emotions and dispositional mindfulness work together to affect FertiQoL. Interventions aiming to improve FertiQoL in women with RPL should consider targeting these aspects.

Keywords: Mindfulness; Moderated mediation model; Negative emotions; Perceived stress; Quality of life; Recurrent pregnancy loss.

MeSH terms

  • Abortion, Spontaneous / psychology*
  • Adult
  • Cross-Sectional Studies
  • Depression / psychology
  • Emotions / physiology*
  • Female
  • Fertility / physiology*
  • Humans
  • Mindfulness / methods*
  • Pregnancy
  • Quality of Life / psychology
  • Stress, Psychological / psychology*