According to the McMaster Model of Family Functioning (MMFF) theory (Epstein et al., 1983), family functioning is defined as whether a family can perform various tasks for the family and its members’ healthy development. Family functioning considers the family as a system. It examines the overall function of the family system in seven dimensions, including Problem Solving (PS), Communication (CM), Roles (RL), Affective Responsiveness (AR), Affective Involvement (AI), Behavior Control (BC), and General Functioning (GF; Epstein et al., 1983). It is a fundamental indicator of family system functioning within the family system and is closely related to the individual’s mental health (Shek, 2002b). However, family functioning is more likely to involve more challenges during different periods of the family life cycle. The Modernized Family Life Circle theory separates the development of a family into five main stages, including young single, young married without children, other young, middle-aged, and older. Within these stages, 13 sub-categories indicate different turning points of family development, such as marriage, childbirth, divorce, or widowed (Murphy and Staples, 1979). These periods are considered more vulnerable during family development as a family is probably experiencing role change, responsibility shifting, and living environment changes.

Early pregnancy is also essential in the development of a family, which faces more challenges at this time. Of particular note is that contextual theory suggests that personal development and family functioning are viewed as adaptive processes to external challenges in biological, perceptual, cognitive, behavioral, and interpersonal perspectives (Luthar, 2003). Pregnant families certainly face more complex situations that require adjustment by each family member throughout these perspectives. They are more likely to be challenged by shifting responsibilities, changing roles, and psychosocial distress during this period. As previous studies suggested, expectant fathers must adapt to working and family responsibilities, adjust to a new role, and so on. These responsibilities would result in tiredness and stress, which increases irritability in facing problems (Fägerskiöld, 2008) and further impair family functioning possibly. Also, the expectant mother will be challenged by stress from occupational shifting (Horne et al., 2005), multiple role changes in life, as well as anxiety from various somatic discomfort, and psychological changes (Bjelica and Kapor-Stanulovic, 2004). Researchers and health professionals emphasize the importance of family functioning, and early pregnancy is considered a vulnerable time in the family, which reinforces the importance of paying more attention to family functioning in early pregnancy.

Generally, family functioning is found to influence people’s health mentally and socially and is associated with mood disorders. According to previous research, impaired family functioning is likely to increase the risk of depression and is associated with anxiety (Wang et al., 2013). Not only depression and anxiety but family functioning and bipolar disorder episodes mutually fluctuate and influence each other (Uebelacker et al., 2006). The impaired family functioning would also impact people socially. Researchers revealed that teenagers with an impaired family functioning environment are likelier to engage in violence and later violence perpetration (Gorman-Smith et al., 2004). Besides, family functioning also plays a vital role in the health of family members during pregnancy. On the one hand, impaired family functioning would increase the likelihood of symptoms of depression and anxiety in pregnant females and their partners during early pregnancy (Qin et al., 2022). On the other hand, maternal exposure to poor family functioning during pregnancy would influence the offspring’s brain development in the hippocampus (Xerxa et al., 2021) and increase their vulnerability to being victimized by peers in the future (Lereya and Wolke, 2013).

Furthermore, earlier studies have identified the importance of dimensions in family functioning. CM and GF of family functioning could directly predict anxiety in the general population (Ballash et al., 2006), and four dimensions in family functioning (PS, CM, RL, and GF) are specifically associated with suicide attempts in bipolar disorder (Berutti et al., 2016). Therefore, to contribute to the understanding of family functioning, the dimensions should be closely studied as they would play a role in updating the guidance of family education and interventions.

However, limited research has been conducted in early pregnancy groups. Thus, this study aimed to explore the characteristics of family functioning in early pregnancy among Chinese women and partners and to examine the associated factors simultaneously. Recognizing and promoting an understanding of the underlying characteristics of family functioning during pregnancy will facilitate the development of more effective family interventions for early pregnant families.

Numerous studies have acknowledged the negative impact of family dysfunction on the general population or individuals with mental disorders, but the understanding of family functioning in early pregnancy remains unclear. Based on the established knowledge of the special family functioning problems, this study focused on the characteristics of family functioning in early pregnancy and associated factors with promoting a basic understanding of family functioning in pregnant women and their partners.

In this study, BC was the only dimension of family functioning that was dysfunctional in participants. In particular, the rate of dysfunctional BC was the highest and prominently exceeded that of healthy BC both in pregnant women and partners compared to other dimensions. According to the MMFF theory, family functioning of BC refers to family patterns that deal with family members’ behaviors to meet and express needs and motivations in risky situations or social environments, including “We do not know what to do when an emergency comes up” “If the rules are broken, we do not know what to expect” “There are rules about dealing with dangerous situations” and so on (Epstein et al., 1983). Findings in the present study suggest that pregnant families may face more adaptive behavior conflicts in various situations. Under the environment of social transition, Chinese traditional family values, obligation, and collectivism have been challenged by the rapid social transition in urbanization and industrialization, as well as the promotion of individualism (Xu and Xia, 2014). Therefore, family rules under the transition of the sociocultural environment might face more challenges, especially during pregnancy.

Improving the quality of family functioning are likely to promote mental health among family members. In the present study, early-pregnancy females and males with poor family functioning of BC showed more severe depressive and anxious symptoms. Available evidence supported the finding, as researchers revealed that family dysfunction is an accompaniment of an acute depressive episode commonly, and consistently impaired family functioning might influence the course and severity of depression (Gabor and Ivan, 1990). Family functioning was also important in predicting perinatal depression and related interventions (Huang et al., 2021). Within the biobehavioral family model (BBFM), the approach posits that family emotional climate, the quality of parent relations and parent–child relationship security, and biobehavioral reactivity can influence each other collectively in stress-related illness. It reveals that an insecure family environment and low-quality parent relations would generate implicit and explicit impacts on each individual in the family (Wood et al., 2008). BBFM values family in three aspects, including the intensity of emotional exchange, parent interaction patterns in support, understanding, and conflict. These perspectives reflect the quality of family functioning laterally and are tightly related to each family member’s performance in BC. Combining clinical and theoretical findings, family functioning plays a vital role in adjusting the individual’s mental health. It also underlined a critical aspect of environmental factors leading to mental illness and provided a potential pathway to promote females’ and partners’ mental health during the first trimester.

Additionally, dysfunctional BC was negatively associated with the time lived with a partner and the quality of life in females. It indicates that the longer females and their partners live together, the better the family functioning of BC might have. Traditionally, Chinese culture values the continuity of ethnicity and bloodline. Newly married couples are likely expected to have a pregnancy at an early stage after marriage (Yang et al., 2018). Even though many families and young people have been affected by the new age thinking in relationships and marriage by cross-cultural concepts and individualism, cohabitation has started emerging but remains marginalized in the Chinese population (Xu and Xia, 2014). Thus, before marriage and childbirth, parents during early pregnancy might spend less time adapting to the family environment and new responsibilities as first-time parents and make adjustments in BC. Besides, researchers also revealed that BC is largely independent of other FAD scales as it determines the vital pattern of the standard behavior in each family (Ridenour et al., 1999) and suggests that BC can distinguish clinical and nonclinical families (Miller et al., 1985). These findings reinforced the significance and uniqueness of BC in family functioning. Also, it offers a potential pathway for family education and mental health providers to help families in early pregnancy improve family mental health and the functioning of BC under various situations by intervening in BC independently and assisting parents during early pregnancy adapting to family environments.

In sum, the results of the present study highlighted that maintaining good family functioning in BC might be a challenge for women and partners during early pregnancy, which requires more clinical attention and health education. It also provided insight into improving family wellness and pinpointing guidelines to promote family functioning during early pregnancy.

Although this study found some clinically significant results, it still had the following shortcomings. Firstly, it was a cross-sectional study that could not reveal the characteristics of changes in family functioning during pregnancy. Secondly, there might be some differences and correlations in family functioning between pregnant females and partners generally. For example, in the current study, the mean score of FAD-AI in females was significantly below the cut-off score while there was no statistical significance in partners. Considering some partners of pregnant women failed to participate in the present study, we could not examine the themes mentioned above in the form of maternal-partner pairs because this paired format may better facilitate the exploration of differences and correlations. Thirdly, the data collection from partners in this study was primarily conducted online, given the relative complexity of completing the SSRS and Q-LES-Q-SF scales that may require on-site instruction, so in this case, partners’ social support and quality of life were not assessed. Additionally, factors related to family functioning included in this paper were not comprehensive. In general, the maternal pressures and opinions are different from their partners, especially in caring baby, and these may also further impact the family function, which was not explored in this study and needed to be included in the future.

Early pregnancy is a vulnerable period of dysfunctional family functioning. The current study revealed that the dysfunctional family functioning of BC was most prominent both in females and partners in early pregnancy. Length of time living with a partner, depressive and anxious symptoms, and quality of life were associated with dysfunctional family functioning of BC in this period. The findings in this research highlighted the need for public and clinical awareness of family functioning during early pregnancy and underlined a possible guideline for family education for this period.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

The studies involving human participants were reviewed and approved by The Second Xiangya Hospital of Central South University. The patients/participants provided their written informed consent to participate in this study.

LL, YZ, BL, and XQ contributed to the study’s conception and design. XQ, SX, MM, XF, XN, JL, YJ, LZ, and BL are responsible for participant recruitment and data collection. XQ and WZ did the data analysis and wrote the first draft of the manuscript and revisions. BL, XQ, YZ, and HL contributed substantial revisions to the manuscript. All authors contributed to the article and approved the submitted version.

The work has been supported by The National Natural Science Foundation of China (82001437 and 82171518); and the Key Program of Hunan Health Commission (202205033887). The funding sources had no role in the study design, data collection and analysis, interpretation of the data, preparation and approval of the manuscript, and decision to submit the manuscript for publication.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.