Abstract
Objectives: The aim of this study was to establish a structural model that could explain and predict factors influencing health-related quality of life (HRQoL) in high-risk pregnant women. Methods: This study adopted a structural equation model based on the HRQoL model. Data were collected from 200 high-risk pregnant women hospitalized in a maternal-fetal intensive care unit. Structured questionnaires measured antenatal depression, marital intimacy, fetal attachment, self-care behavior, perceived health status, and HRQoL. All data were collected simultaneously during a single point in participants' hospitalization. Results: Among the factors, antenatal depression showed the greatest influence on HRQoL (β = -0.27, p < 0.001), followed by marital intimacy (β = 0.26, p < 0.001), fetal attachment (β = 0.25, p < 0.001), perceived health status (β = 0.14, p = 0.005), and self-care behavior (β = 0.12, p = 0.037), with an explanatory power of 73.4%. Conclusions: To improve the HRQoL of high-risk pregnant women, psychological nursing intervention strategies are needed to reduce antenatal depression. It is necessary to provide education that encourages self-care behavior. Furthermore, the findings indicate that strategic nursing interventions are necessary to enhance marital intimacy, fetal attachment, and perceived health status. As a theoretical basis, this study will contribute to the preparation of basic data that will improve the HRQoL of pregnant women at high risk.