There are several limitations to this study. First, the use of the LOT-R has not been formally validated among Chinese pregnant women. However, the instrument has been used repeatedly in China [39] [40] [41] [42] [43] [44] [45] [46] 59] and it was carefully pretested in this population prior to study implementation. Our focus groups and pilot testing did not indicate any difficulties in interpretation of these items. Nonetheless, the instrument may benefit from a more rigorous validation study in this population. Also, the use of a cross-sectional convenience sample that includes mostly primiparous women limits inference to a wider population of pregnant Chinese women. In this study, all women presenting to the clinic were asked to participate, and it is possible that the women presenting during this study period were different from the larger population of pregnant women in Beijing. Future studies would benefit from a design that includes random selection at a variety of institutions across Beijing and across China.