Journal of Education and Health Promotion

Abstract BACKGROUND: Gestational diabetes is the most common medical complication and a common
metabolic disorder during pregnancy. Increasing people’s self‑efficacy is one of the best ways to
control this disease. As there is a lag of intervention in this regard, the purpose of this study was to
determine the effect of couple supportive counseling on self‑efficacy in women with insulin‑treated
gestational diabetes.
MATERIALS AND METHODS: In this randomized clinical trial, 64 women with gestational diabetes
who referred to diabetes clinic of Mashhad Ommolbanin Hospital were divided into intervention and
control groups through block randomization during 2019. Their gestational age was in 26–30 weeks.
For the couples in the intervention group, three couple supportive counseling session was held. Each
session lasted 1 h and was held one time per week. The instruments were diabetes self‑efficacy
questionnaire, fasting and 2‑h postprandial checklist and Cassidy social support, which were assessed
before and 4 weeks after intervention in both groups. Data was analyzed by SPSS software version 25
through Mann–Whitney and Wilcoxon test. P values of < 0.05 were reported to be significant.
RESULTS: In the preintervention, the diabetes self‑efficacy score had no significant difference
in the intervention (30/6 ± 38/50) and control groups (09/8 ± 56/51) (P = 515/0). However, in
the postintervention, the diabetes self‑efficacy score was significantly higher in the intervention
group (58/6 ± 41/71) compared to the control group (15/7 ± 31/51) (P < 001/0). Also, before the
intervention, there was no significant difference between the intervention (30/2 ± 72/10) and control
group (87/1 ± 63/11) (P = 137/0) regarding social support. However, after the intervention, there was
a significant difference between the intervention and control groups (879/0 ± 53/13, 03/2 ± 41/11,
P < 0/001 respectively). Also, data analysis showed a significant correlation between self‑efficacy
and social support (r = 0.451, P < 0.001), self‑efficacy and fasting blood sugar (P < 0.001, r = ‑0.577),
and 2 h post prandial (r = ‑0.778, P < 0.001).
CONCLUSION: Couple supportive counseling leads to increased self‑efficacy and social support
in pregnant women with gestational diabetes. Therefore, it is recommended to use this counseling
as an effective method in the management of diabetic pregnant women during their prenatal care
to have a healthier pregnancy.

Abstract BACKGROUND: Physical changes in high‑risk pregnancy (HRP) can lead to changes in mood and
social relationships and negative effects on women’s well‑being. Individuals in different sociocultural
contexts have different perceptions of well‑being. Yet, there is limited information about perceptions of
well‑being in HRP. This study aimed to explore the Iranian women’s experiences of well‑being in HRP.
MATERIALS AND METHODS: This qualitative study was conducted in 2019–2020 through directed
content analysis based on the conceptual framework of well‑being in HRP. Participants were 26
women with HRP purposively recruited from public and private healthcare settings in Mashhad, Iran.
Face‑to‑face semistructured interviews were held for data collection until data saturation. Data were
analyzed through directed content analysis proposed by Elo and kyngäs (2008) and were managed
using the MAXQDA (v. 10) program.
RESULTS: Well‑being in HRP had seven attributes in the five main dimensions of physical,
mental‑emotional, social, marital, and spiritual well‑being. The seven attributes of well‑being in HRP
were controlled physical conditions, controlled mood, emotions, and affections, perceived threat,
self‑efficacy, and competence for multiple role performance, maintained social relationships, meaning
seeking and relationship with the Creator, and positive marital relationships.
CONCLUSION: The present study provide an in‑depth understanding about well‑being in the Iranian
women with HRP. It is a complex and multidimensional concept with physical, mental‑emotional,
social, marital, and spiritual dimensions. Comprehensive multicomponent interventions are needed to
promote well‑being among women with HRP and designed the guidelines to provide woman‑centered
care.

Abstract Self‑care may help prevent pregnancy complications and mortality by informing parents. Mobile
health applications (apps) can help individuals to improve the quality of self‑care. Although it has
been claimed that mobile apps have various benefits, their functionalities in pregnancy self‑care
are still unclear. A clear understanding of current apps can help researchers, practitioners, and app
developers to identify appropriate functionalities for new development and future refinement of current
apps. This review endeavored to identify appropriate functions for pregnancy self‑care mobile apps
and user interface (UI) features. The scope of this review integrates self‑care for pregnancy apps
published in Google Play and Cafe Bazaar (an Iranian Android marketplace), popular Android app
stores, from July to October 2019 by sing the systematic search technique. All 4196 downloaded apps
were installed, and it was found that 76 of them met the inclusion criteria. This way, their features
were extracted and categorized by the conventional content analysis. Three main themes and 69
subthemes in terms of apps functionalities and their UI features were extracted as follows: 1) Training
materials (maternal and paternal) with 27 subthemes; 2) self‑care functionalities (consultations, fetus
tracking, clinical examination, supportive assistance, and reminders) with 26 subthemes; and UI
features with 16 subtheme. The findings underlined the mHealth solutions for pregnancy self‑care
and the need for development of the apps regarding the extracted functionalities and UI features;
however, controlled trials are needed. It is recommended that transparent reporting of mHealth
interventions needs to be prioritized to enable effective interpretation of the extracted data.

Abstract BACKGROUND: In the last 20 years, the public health community has expressed concerns over
the unprecedented increase of cesarean section (CS) delivery. Rising global concerns over this
escalation that has gone out of control should not be overseen. The purpose of this study is to
develop an application‑based education model and prenatal yoga to reduce the occurrence of
cesarean section (CS) delivery.
MATERIAL AND METHOD: This studywasan exploratory mixed methodsresearchthat consisted of
twostages: stage 1, which wasa qualitative study on model formulation through in‑depth interviews
and forum group discussions (FGDs); and stage 2, which aimed to test whether the formulated model
was effective in reducing the occurrence of cesarean section delivery.
CONCLUSION: The result of this study wasused todevelop an application‑based education model,
which wascombined with prenatal yoga, to reduce the occurrence of cesarean section delivery.

Abstract BACKGROUND: The expansion of pregnancy‑related mobile applications has led to an increase
in the usage of these applications by Iranian women, which has the potential to have a long‑term
impact on women’s pregnancy health and, as a result, community health. The goal of this research
was to investigate the state of pregnancy‑related mobile applications in Iran.
MATERIALS AND METHODS: This was a descriptive‑applied research approach which was
conducted in 2020. One hundred and fifty‑seven pregnancy apps from different Iranian mobile app
markets were installed and were examined in terms of the resources used and their validity, subject
distribution, participation of obstetricians in the app development, apps volume, rank acquired by
users and distribution of apps according to the developers. The relationship between the number of
resources used and user rankings was also tested.
RESULTS: A total of 157 apps were categorized into 12 subject categories based on their content.
Only 1.3% of the apps were developed with the participation of obstetricians. Only 5% of the apps
had used reliable information resources. Furthermore, the number of resources referenced in the
studied apps did not have a significant relationship with star ratings (r = 0.03, P = 0.64), according
to the Pearson correlation test.
CONCLUSION: Iranian mobile applications in the field of pregnancy have grown significantly in
terms of quantity, subject diversity, and user acceptance; however, the credibility of the information
in these apps cannot be validated. This serves as a reminder to users to exercise caution while
using such apps.

Abstract BACKGROUND: Improving self‑care in adolescent pregnancy leads to improved maternal and
neonatal outcomes of pregnancy. However, self‑care in adolescent pregnancy is less than other
women. The aim of this study was to compare the effect of face‑to‑face training and telemedicine
on self‑care in adolescent pregnant women.
MATERIALS AND METHODS: The present study is a quasi‑experimental study that was conducted
in Zahedan in 2021 and 120 adolescent pregnant women with a gestational age of 15–20 weeks
participated in it. The sampling was done in multistage, and the samples were divided into three groups:
Face‑to‑face training, telemedicine, and control. Face‑to‑face training was presented in five sessions
and the telemedicine group received the similar educational content through the mobile applications.
The samples completed a researcher‑made self‑care questionnaire before the intervention and at
28 weeks of gestation. SPSS software version 21 was used for the analysis, and data were analyzed
by ANOVA, Tukey post hoc, Kruskal–Wallis, and Mann–Whitney tests.
RESULTS: There was no significant difference in face‑to‑face and telemedicine training in improving
the scores of nutritional performance, smoking and narcotics use, personal hygiene, and routine
pregnancy care (P > 0.05), but face‑to‑face training caused more improvement in the scores of
sports and physical activity as compared to telemedicine group (P = 0.04). Face‑to‑face training
and telemedicine training in all domains led to a significant improvement in scores as compared to
the control group (P < 0.05).
CONCLUSION: The results of this study showed that the face‑to‑face training and telemedicine
methods were proper methods for self‑care education in pregnant adolescent women. It is
recommended to use these methods in promoting self‑care in pregnant adolescent women.

Abstract BACKGROUND: In the COVID‑19 outbreak, women with a history of miscarriage need more mental
health. Anxiety and meta‑worry as consequences of miscarriage, besides concerns due to pregnancy
during coronavirus, show the necessity of appropriate online and face‑to‑face educational counseling.
This study aimed to evaluate the effectiveness of online metacognitive educational counseling versus
face‑to‑face method on anxiety and meta‑worry in these women.
MATERIALS AND METHODS: In this randomized clinical trial, 80 women with a history of
miscarriage, anxiety, and meta‑worry referred to Imam Jafar Sadegh hospital (labor, women ward
and women clinic), Meybod, Iran, were selected conveniently and randomly assigned into two
groups (n = 20/each). The participants received 8‑session metacognitive educational counseling
package online or face‑to‑face. Data were collected by Beck Anxiety Inventory, Wellz meta‑worry
questionnaire at baseline, week eight, and follow up as primary outcomes and analyzed via SPSS
software (Anova and Repeated measure statistic tests).
RESULTS: Anxiety in the 12th week (online group 13.75 ± 3.59 vs. face to face 18.25 ± 5.91,
P = 0.04) was statistical significantly less than baseline (respectively 22.15 ± 5.67 vs. 22.35 ± 4.93,
P =  0.56); with fewer anxiety scores in the online group. Meta‑worry in the 12th week (online
group 11.90 ± 2.59 vs. face to face 15.70 ± 4.06, P = 0.03) was statistically significant compared to
baseline (respectively 17.15 ± 2.70 vs. 18.50 ± 3.47, P = 0.36); with fewer meta‑worry scores in the
online group. Belief about worry in 12th week (online group 66.50 ± 14.60 vs. face to face 78.45 ± 9.27,
P = 0.01) was statistical significantly less than baseline (respectively 85.50 ± 8.87 vs. 86.05 ± 8.85,
P = 0.96); with less score of belief about worry in the online group.
CONCLUSION: Online and face‑to‑face metacognitive educational counseling methods decreased
anxiety, meta‑worry, and belief about worry in women with miscarriage. But online educational
counseling was more effective. Distance online counseling in COVID‑19 can help the mental health
of women with miscarriage.

Abstract BACKGROUND: Asymptomatic bacteriuria (ASB) is commonly seen during pregnancy due to the
various morphological, hormonal, and physiological changes the body undergoes. If left undiagnosed,
it can lead to conditions such as pyelonephritis and preterm delivery which could culminate in causing
maternal and fetal morbidity and mortality. Therefore, this study aims to determine the prevalence,
risk factors, microbial profile, and antibiotic susceptibility patterns associated with ASB in a tertiary
healthcare center.
MATERIALS AND METHODS: A cross‑sectional study was carried out where 150 urine samples
were obtained from pregnant women within the gestational age of 13–36 weeks. Randomized
stratified sampling was the method of sampling used. A questionnaire was also administered to
them to determine potential risk factors. The samples were cultured and identified using biochemical
tests. Antibiotic susceptibility tests were carried out by Kirby–Bauer disc diffusion method. Statistical
analysis was carried out using Chi‑square test. The graphs and tables were generated using Microsoft
Excel and Word.
RESULTS: Out of the 150 samples that were obtained, 8 samples had significant bacteriuria which
is a prevalence of 5.33%. Escherichia coli was the most frequently isolated organism accounting
to 45% of the isolates. The other organisms that were isolated were Enterococcus, Klebsiella
pneumoniae, Coagulase negative staphylococcus (CONS), Candida albicans, and Group B
Streptococcus which measured to 11% of the total distribution each. In the antibiotic sensitivity
tests, among the gram‑negative isolates, marked resistance to Ampicillin and Amoxycillin along with
sensitivity to Cotrimoxazole and Nitrofurantoin. Of the gram‑positive isolates, there was sensitivity
to Ampicillin and Nitrofurantoin. A positive correlation was seen between the age groups of 23–27
and the prevalence of ASB.
CONCLUSION: The prevalence of ASB in this study shows that ASB is not uncommon in the
population. Despite the World Health Organization (WHO) guidelines and National Health Mission
recommendations to make urine check‑ups a routine, it not carried out, possibly due to cost
implications. However, it poses a risk for severe maternal and fetal outcomes and hence, should be
screened for on a regular basis. Thus, this study emphasizes the importance of screening pregnant
women for ASB for promoting better maternal and fetal health.

Abstract BACKGROUND: Pregnant women experience falls, particularly in the third trimester. In this 
population, physiological changes, as well as ligament laxity, might influence joint proprioception and 
do not return to normal during the postpartum period. The prevalence of falls during pregnancy and 
postpartum periods imposes a need to study proprioception in pregnant women and the postpartum 
period. 
MATERIALS AND METHOD: An observational longitudinal study was conducted in June 2018 in 
outpatient clinic Chinchwad Pune. A total of 36 primiparous women were included in the study by using 
purposive sampling. The mean and standard deviation of the age was 25.92 (2.59). Proprioception 
was assessed for the knee joint and the ankle joint during the third trimester of pregnancy and 6th and 
12th week postpartum. Outcomes included were the Joint Reposition Test for both knee and ankle 
joints using UTHSCSA Image Tool Software 3.0. Repeated‑measure ANOVA was performed for the 
normally distributed data, and nonparametric test Friedman’s test was performed for data that were 
not distributed normally. The data was statistically analyzed using the SPSS software version 26. 
The level of significance was set at 0.05, confidence intervals of 95% were used. 
RESULT: The result revealed significant (P < 0.05) improvement in both knee and ankle proprioception 
during the third trimester of pregnancy and postpartum period 6th and 12th week. 
CONCLUSION: Knee proprioception and ankle proprioception were found to improve significantly 
during the postpartum period 6th and 12th weeks compared to the third trimester of pregnancy but do 
not return to the prepregnancy state.

Abstract BACKGROUND: Preconception reduces unplanned pregnancies and plays an important role in 
reducing maternal and infant mortality. Considering the importance of these care services, this study 
was conducted to determine the status of preconception care (PCC) model with Structural Equation 
Modeling (SEM).
MATERIALS AND METHODS: This cross-sectional descriptive study was conducted on 394 pregnant 
women referring to Gorgan’s health centers. Samples were selected by multi‑stage stratified sampling 
method. The instrument used in this research was a researcher-made questionnaire by Bayrami. Data 
were analyzed using R software version 4.1.4. Structural equation modeling (SEM) with weighted 
least square mean and variance method was used to fit the conceptual model and the significance 
level of the tests was considered 0.05.
RESULTS: The results showed that PCC model was deemed appropriate as optimum conditions 
indicators of goodness of fit; knowledge with a coefficient of 0.182 leads to self‑efficacy (SE), and 
SE affects the accessibility of facilities with a coefficient of 0.465 and the expected outcome with a 
coefficient of 0.500. After facility structure with a coefficient of 0.500, SE construct with a coefficient 
of 0.215 had the most effect on performing PCC behavior.
CONCLUSIONS: Facilities and SE as a key element of empowerment have an important role in 
promoting PCC. Identifying the factors associated with this care appears to help health policymakers 
to planning for these caregivers more precise and sensitive.

Abstract BACKGROUND: The loss of a pregnancy can result in grief, guilt, self‑doubt, anxiety, and
post‑traumatic stress disorder (PTSD). Considering the side effects mentioned for mental health
and the fact that the symptoms will linger if left untreated and even adversely affect the subsequent
pregnancies. The current study was designed to assess the impact of individual counseling on stress,
anxiety, and depression in mothers with pregnancy loss.
MATERIALS AND METHODS: The study commenced 100 women who experienced pregnancy loss
(in Urmia/2018-2019); they were enrolled using convenience sampling and block randomization. The
intervention group received four individual counseling sessions (weekly sessions with a duration of
1 h) based on Warden’s principles. The control group received routine care. The Depression Anxiety
Stress Scale (DASS‑42) was filled out at baseline, the pre‑ and post‑intervention. Analyses were
performed using the Chi‑square, paired, or individual t‑tests, when necessary. P value < 0.05 was
considered significant.
RESULTS: There were no significant differences regarding socio‑demographic characteristics and
clinical features between groups at baseline. Intra‑group analysis showed that all outcome measures
in the intervention group were significantly improved. According to inter‑groups analysis, a significant
association was found between pre‑test and post‑test in the intervention group (P < 0.05).
CONCLUSION: Results of this study can clarify the psychological effects of pregnancy loss in these
mothers and help the officials and responsible parties to plan the treatment and rehabilitation of these
women and include them in the healthcare system.

Abstract BACKGROUND: The severe acute respiratory syndrome coronavirus (SARS‑CoV‑2) has become
a public health concern worldwide. It is important for pregnant women to know about the mode of
transmission, symptoms, and preventive measures against COVID‑19. The aim of this study was
to evaluate the awareness and outlook of pregnant women and practical measures taken by them
against COVID‑19.
MATERIALS AND METHODS: This cross‑sectional questionnaire‑based study was conducted for
1 month (June 10, 2020– July 10, 2020) in the Department of Obstetrics and Gynecology, All India
Institute of Medical Sciences, Jodhpur, Rajasthan, India. A prevalidated questionnaire was given to
109 pregnant women to assess the knowledge, attitude, and practice acquired against COVID‑19
infection. The Chi‑square test or Fischer’s exact test was used to compare categorical data.
RESULTS: Among 109 participants, 103 (94.5%) had good knowledge, 4 (3.7%) had average
knowledge and 2 (1.8%) had poor knowledge about COVID‑19. Majority of them had a positive
attitude for the protective measures taken for the prevention of disease.
CONCLUSIONS: Since there is no valid treatment for COVID‑19, prevention is the only key to curve
this infection. In the present study, 94.5% pregnant women had overall good knowledge score about
the ode of transmission, symptoms, and preventive measures against COVID‑19.

BACKGROUND: The severe acute respiratory syndrome coronavirus (SARS‑CoV‑2) has become
a public health concern worldwide. It is important for pregnant women to know about the mode of
transmission, symptoms, and preventive measures against COVID‑19. The aim of this study was
to evaluate the awareness and outlook of pregnant women and practical measures taken by them
against COVID‑19.
MATERIALS AND METHODS: This cross‑sectional questionnaire‑based study was conducted for
1 month (June 10, 2020– July 10, 2020) in the Department of Obstetrics and Gynecology, All India
Institute of Medical Sciences, Jodhpur, Rajasthan, India. A prevalidated questionnaire was given to
109 pregnant women to assess the knowledge, attitude, and practice acquired against COVID‑19
infection. The Chi‑square test or Fischer’s exact test was used to compare categorical data.
RESULTS: Among 109 participants, 103 (94.5%) had good knowledge, 4 (3.7%) had average
knowledge and 2 (1.8%) had poor knowledge about COVID‑19. Majority of them had a positive
attitude for the protective measures taken for the prevention of disease.
CONCLUSIONS: Since there is no valid treatment for COVID‑19, prevention is the only key to curve
this infection. In the present study, 94.5% pregnant women had overall good knowledge score about
the mode of transmission, symptoms, and preventive measures against COVID‑19.

Abstract BACKGROUND: Maternal knowledge is one of the indirect causes of maternal mortality in Indonesia. 
Maternal knowledge that mothers must possess includes knowledge about pregnancy, childbirth, and 
postpartum. Maternal knowledge should be provided during pregnancy. The aim of this study is to 
identify maternal knowledge in postpartum women who have a history of the frequency of pregnancy 
visits according to the minimum standard.
MATERIALS AND METHODS: A descriptive quantitative design was performed by assessing 
maternal knowledge to postpartum mothers using an online questionnaire which conducted in 2020 
at two public health centers of Surabaya, Indonesia. A sample of this research involved postpartum 
mothers who completed inclusion criteria, namely physiological postpartum mothers and had regular 
pregnancy at least 6 antenatal care (ANC) visits. In contrast, the exclusion criteria were postpartum 
mothers who were not included in the target areas of research. It uses random sampling techniques 
and performs an analysis using descriptive statistics.
RESULTS: Three research questions showed a large percentage of wrong answers, namely 
preparation to face complications (64%), contraceptive methods in breastfeeding mothers (50%) and 
the first time using contraception during childbirth (42%). Meanwhile, all the correct results (100%) 
are exclusive breastfeeding and supplementary feeding for babies.
CONCLUSION: Completing minimal standards of ANC visits cannot ensure adequate maternal 
knowledge, particularly crucial health information that influences maternal and neonatal health status.

Abstract BACKGROUND: This cross‑sectional study aimed to evaluate attitudes and knowledge regarding 
oral health and infant oral health among pregnant women.
MATERIALS AND METHODS: The study involved 325 pregnant women in the Republic of Croatia 
who completed an anonymous online questionnaire (Google forms) from January to June 2019. The 
questionnaire was divided into three parts. The first part contained questions about the demographic 
data experience about oral health in pregnancy. The second part was related to the knowledge of 
the relationship between oral health and pregnancy. The third section consisted of questions related 
to knowledge about the oral health of children at the earliest age. The results were analyzed with 
descriptive statistics, Spearman correlation analysis, and Chi‑square test.
RESULTS: The women are mostly informed about oral health in pregnancy from their dentists (53.54%) 
and least from their general doctors (4%). In pregnancy, gingival bleeding was observed by 52.31% 
of respondents and tooth mobility by 12.31%. The Chi‑square test found that there was a difference 
in attitude regarding the age at which they should stop breastfeeding between respondents who had 
their first pregnancy and those who already had children. Only 9.23% of respondents are aware that 
breastfeeding can cause tooth decay.
CONCLUSION: Pregnant women in the Republic of Croatia do not have sufficient knowledge, and 
they are neither aware of the importance of oral health during pregnancy nor infant oral health.

Abstract BACKGROUND: The World Health Organization recommendation requires the development and use
of effective, brief, clear, and evidence‑based education packages to improve health‑care outcomes.
No comprehensive sexual health improvement package exists for the pregnancy period in the Iranian
health system. This study aimed to develop a package to promote sexual health in pregnancy.
MATERIALS AND METHODS: The present study is a qualitative study, which was conducted
in 2019 in Tehran, Iran. Sexual health package during pregnancy was developed based on the
National Institute for Health and Clinical Excellence (NICE) steps. The first step included reviewing of
international guidelines, strategies, handbooks, education packages, and articles in this regard. The
package was developed in the second step. In the third step, quality assessment was performed using
expert opinion with the Appraisal of Guidelines for Research and Evaluation Instrument II (AGREE
II) tool, and validation was performed using Delphi method.
RESULTS: Package content was designed in two sections: for midwives and health‑care providers
and for pregnant mothers in three sessions (in each trimester of pregnancy). The quality assessment
using the AGREE II guidelines revealed excellent quality (>89%). The package was validated based
on expert opinion (>95%).
CONCLUSION: The sexual health promotion package during pregnancy was designed with high
quality and validity based on NICE steps. It is recommended, midwives be performed this designed
and validated package in routine pregnancy care to promote the couple’s sexual health.

Abstract BACKGROUND: Pregnancy anxiety is associated with a diverse birth outcomes. Mothers’ education
could have a critical role in increasing their self‑efficacy to defeat their anxiety and improve pregnancy
and child birth outcomes. The study was conducted to examine the effect of intervention based on
self‑efficacy theory on pregnancy anxiety and child birth outcomes.
MATERIALS AND METHODS: The study was conducted as a quasi‑experimental design on
60primiparous women (26–28 weeks) in Birjand (East Iranian province) from May to September 2017,
who were randomly divided into intervention and control groups. The intervention group received
8 sessions of 90‑min educational intervention based on self‑efficacy theory strategies besides the
routine prenatal care. Vanden Bergh’s pregnancy anxiety questionnaire and checklist of pregnancy
and delivery outcomes were used for data collection.
RESULTS: The level of pregnancy anxiety was similar in both groups before the intervention, but
immediately and 1 month after the intervention, the mean score of pregnancy anxiety significantly
reduced in the intervention group and significantly increased in the control group (P < 0.001). There
was a significant difference in mean neonatal weight (P < 0.001) between the two groups. Emergency
and elective cesarean section were significantly lower in the intervention group compared to the
control group (P < 0.001), but there were no significant differences in the frequency of preterm
delivery between two groups (P < 0.05).
CONCLUSION: The results provide support for the effectiveness of intervention based on self‑efficacy
theory in reducing pregnancy anxiety and enhancing positive pregnancy outcomes. Hence,
theory‑based educational interventions may serve as a cost‑effective and noninvasive approach to
reduce pregnancy anxiety in Iran.

Abstract BACKGROUND: One of the useful models in health education is the Beliefs, Attitudes, Subjective
Norms, and Enabling Factors (BASNEF) model. The model is used to study behavior and to plan
for change it and to determine the factors that influence people’s decision‑making. The aim of this
study was to investigate the factors affecting the nutritional behavior of pregnant women based on
BASNEF model.
MATERIALS AND METHODS: This cross‑sectional study was performed on 360 pregnant women
referring to health centers of Tabriz‑Iran by two‑stage cluster sampling method from April to December
2016. Data were collected using sociodemographic, nutrition subdomain of Health Promoting
Lifestyle‑II (HPLP‑II), and researcher‑made questionnaire based on constructs of BASNEF model.
Data were analyzed using the SPSS software version 21 and Pearson correlation test and General
Linear Model (GLM).
RESULTS: Mean ± standard deviation (SD) of nutrition subdomain of HPLP‑II was 24.65 ± 4.75
within the range 9–36. Mean ± SD of BASNEF model constructs (score range) was also obtained
as 45.30 ± 10.80 (0–100), 17.98 ± 2.40 (8–24), 9.30 ± 2.82 (0–20) and 2.47 ± 1.74 (0–6) for belief,
attitude, subjective norms, and enabling factors, respectively. Based on the GLM, there was significant
relationships between nutritional behavior and BASNEF model constructs (belief [P < 0.001],
attitude [P = 0.043], enabling factors [P < 0.001], and subjective norms [P = 0.038]) as well as the
variables of job, husband’s education, and job and sufficiency of income for expenses.
CONCLUSION: The results of the present study showed the impact of BASNEF model constructs
and some sociodemographic variables on nutrition behaviors in pregnant women. Therefore, in order
to improve nutrition behaviors of pregnant women, designing and implementation of interventions
based on the BASNEF model are recommended.

Abstract BACKGROUND: Maternal attachment to the fetus is a term used to describe the emotional relationship
between mother and fetus. This emotional connection increases during pregnancy and is reflected
in her feelings, perceptions, and behaviors. Mindfulness is important as one of the factors affecting
the mental health of people during pregnancy. Therefore, the present study was conducted to
determine the relationship between the dimensions of mindfulness and maternal attachment to the
fetus during pregnancy.
MATERIALS AND METHODS: The present study was performed on 500 pregnant mothers referred
to health centers affiliated to Isfahan University of Medical Sciences. The samples were entered into
the study by available sampling method and if they had inclusion criteria and no exclusion criteria.
The research instruments were the Fetal Attachment Questionnaire and the Bauer Mindfulness
Questionnaire. The collected data were analyzed by SPSS software version 22.
RESULTS: The results of the data showed that there was no significant relationship between the
overall score of mindfulness and the overall score of maternal attachment to the fetus (P = 0.62).
While from the dimensions of mindfulness such as “action with awareness” there was a significant
negative relationship (P = 0.03) with maternal attachment to the fetus and a significant positive
relationship “observation” with maternal attachment to the fetus (P = 0.03).
CONCLUSION: According to the results of this study, there is a relationship between maternal
attachment to the fetus during pregnancy and a number of dimensions of mindfulness. For this
purpose, since mindfulness can increase the mother’s interactions with the fetus, and this interaction
begins during pregnancy and with the mother’s attachment to the fetus, it is important to pay attention
to this.

Abstract BACKGROUND: Pregnancy is a special period in a woman’s life during which physical, mental,
social, and cultural changes would affect sexual desires during this period. The present study was
conducted to compare the effect of face‑to‑face education and using educational films on the sexual
dysfunction in couples.
MATERIALS AND METHODS: The present study was a semi‑experimental research. Study
population contained pregnant women and their husbands. Samples were selected randomly. Data
were gathered using demographic characteristic questionnaire and sexual dysfunction in men and
women questionnaire. Sample size was 96 couples (32 couples in the face‑to‑face group, 32 in the
educational films group, and 32 in the control group). Data were analyzed using SPSS20 software.
RESULTS: The mean total score of preintervention sexual function in face‑to‑face education group
was 46.72 ± 9.79, in educational film group 47.82 ± 13.07, and in control group 43.84 ± 12.76. In
the case of postintervention, it was, respectively, 60.62 ± 9.72, 57.37 ± 14.74, and 43.61 ± 14.21.
Face‑to‑face education led to the treatment of sexual dysfunction during pregnancy (P < 0.001). In
the educational film group (P = 0.40), sexual dysfunction during pregnancy was not treated, but there
was an improvement in sexual function (P = 0.001). In the control group, there was a significant
difference regarding the decrease in the score of sexual function and untreated sexual dysfunction
during pregnancy (P = 0.001). Furthermore, no improvement was observed in the sexual dysfunction
during pregnancy (P = 0.90).
CONCLUSIONS: According to the results, face‑to‑face and film education are effective in sexual
function during pregnancy, but face‑to‑face education in pregnancy is more effective in the treatment
of sexual dysfunction, and so this causes promoting sexual health during this period.

Abstract BACKGROUND: Considering the low level of physical activity in pregnant women in the COVID‑19
pandemic period, and on the other hand, the benefits of mobile application (mobile app) learning,
we decided to conduct a study to determine the impact of educational intervention based on mobile
app on physical activity in pregnant women.
MATERIALS AND METHODS: The present study was quasi‑experimental and examined 93 pregnant
women aged 16–20 weeks of gestation. Sampling was done on pregnant women participating in
the childbirth preparation classes in Isfahan. We used the validated and reliable questionnaire
including perceived benefits, perceived barriers, perceived enjoyment, perceived social support,
and Pregnancy Physical Activity Questionnaire. The intervention was based on mobile app, and the
content of the application contained 12 main domains such as description of physical activity and
benefits and barriers of exercise in the pregnancy, different types of proper pregnancy exercise,
planning for exercise, and different types of exercise. Finally, data were analyzed using SPSS20,
and the Chi‑square test, independent t‑test Paired t‑test were employed. The significance level was
considered to be <0.05.
RESULTS: The results showed that, after the intervention based on mobile app, the mean score
of perceived benefits and enjoyment were significantly higher than before the intervention in
the intervention group. Finally, total mean score of physical activity significantly increased in the
intervention group, while the change decreased in the control group.
CONCLUSION: The results indicated that the use of mobile app can be used to promote physical
activity in pregnant women. Therefore, it is recommended that mobile app education should apply
with face‑to‑face classes in health centers for physical activity in pregnant women in the pandemic
situation.

Abstract BACKGROUND: Postpartum depression and anxiety is one of the most common complications
that women face and cause many problems for mother, baby, and family. Considering the effect of
self‑efficacy on women’s adaptation to pregnancy and delivery conditions and their mental health
during this period, the present study was designed to investigate the effect of pregnancy training
classes based on Bandura self‑efficacy theory on postpartum depression and anxiety and type of
delivery.
MATERIALS AND METHODS: In this clinical trial study, 64 pregnant women were randomly divided
into intervention and control groups. Mothers in the intervention group received pregnancy training
in eight sessions (each session was 2‑hour) from the 20th week of pregnancy. The classes were run
by a trained midwife and the content of the training was based on Bandura self‑efficacy components.
The mothers in the control group received routine care. The demographic‑reproductive information
form, Beck Depression and Spielberger Anxiety Questionnaire were completed by pregnant women
of both groups at several times, before the program, 1 week and 1 month after delivery.
RESULTS: The results showed that the training program significantly decreased the depression
score in 1 week and 1 month after delivery in the intervention group compared to the control group.
In addition, this training program decreased the mean score of apparent and hidden anxiety in the
intervention group 1 month after delivery, although this decrease was not statistically significant.
Furthermore, 80.55% of the intervention group and 58.33% of the control group had vaginal delivery,
which were significantly different between the two groups in terms of the type of delivery.
CONCLUSION: The findings showed that pregnancy training classes based on Bandura self‑efficacy
theory decrease depression and anxiety and increases vaginal delivery rate.

Abstract BACKGROUND: Urinary tract infection is a common infection in women during pregnancy, leading to
many complications for both mother and fetus if untreated. The present study aimed to investigate the
predictability of constructs of the theory of planned behavior (TPB) in adopting urinary tract infection
prevention behaviors in pregnant women.
MATERIALS AND METHODS: In the present cross‑sectional study, we selected 100 pregnant
women who visited the comprehensive health service centers of Zarrinshahr using convenience
sampling from July to September 2019. We collected data by a questionnaire designed based on
the constructs of the TPB and analyzed data using SPSS 20 and linear regression test and Pearson
correlation coefficient. A significant level was considered as α < 0.05.
RESULTS: In the study, the Pearson correlation coefficient showed direct relationships between the
score of behavior and the scores of knowledge (P = 0.005), attitude (P = 0.02), perceived behavioral
control (P < 0.001), and behavioral intention (P = 0.001). Linear regression analysis indicated that
among the above variables, the perceived behavioral control, knowledge, and behavioral intention
were significant predictors of scores of urinary tract infection prevention behaviors, respectively, in
terms of their importance.
CONCLUSION: In this study, perceived behavioral control is detected as the main predictor of
doing urinary tract infection prevention behaviors in pregnant women and should be considered in
designing educational interventions.

Abstract BACKGROUND: Multiple sclerosis (MS) is a chronic disease of the central nervous system. Most
women with MS are diagnosed during their reproductive ages. The aim of this study was to evaluate
the interaction between fertility, pregnancy, and MS.
MATERIALS AND METHODS: A retrospective descriptive–analytic study was conducted on 110
women suffering from MS with a history of pregnancy (between 2007 and 2017 years) in Isfahan,
Iran. Samples were selected in a census model. Women completed a researcher-constructed
questionnaire by telephone. The questionnaire consisted of three parts: demographic information, MS
and its symptoms and treatment, and reproductive system and the history of pregnancy associated
with MS. The data were analyzed by SPSS software version 16 using Chi-square, ANOVA, and t-test.
RESULTS: The mean age of women was 32.4 years. In this population, the average number of
pregnancies was 1.61, the number of deliveries was 1.35, the number of abortions was 0.24, the
history of ectopic pregnancy was 0.01, the number of alive children was 1.36, and the number of dead
children was 0.01. The average time of the last MS attack before the pregnancy was 21.36 months.
Fatigue (24.5%) was the most common symptom exacerbated during pregnancy. MS symptoms
improved in 55.0% of women in the second trimester.
CONCLUSIONS: MS had no effect on the pregnancy status, such as the number of abortions,
ectopic pregnancy, alive and dead children, and the duration of pregnancy. Symptoms of the disease
improved during pregnancy. Therefore, pregnancy has a protective role against MS.

Abstract BACKGROUND: The coronavirus, which is caused by acute respiratory syndrome, appeared in
Wuhan, China, in December 2019 and gradually spread around the world until almost all countries
became infected with the coronavirus. In Iran, the outbreak of coronavirus began on February 21,
2020, with the report of infection of two people in the city of Qom. The aim of this study is to evaluate
the clinical findings of neonates born to pregnant women with corona disease.
MATERIALS AND METHODS: During this case study (February 21 to November 30, 2020), out of
88 pregnant mothers who referred to the hospitals of Shahid Beheshti University of Medical Sciences,
44 live neonates were born from 42 pregnant women with COVID‑19, who were evaluated for clinical
signs by studying their files and reported as a case series, due to limited samples, No statistical
analysis of the study was performed.
RESULTS: In studies of clinical records of hospitalized mothers and infants, among the polymerase
chain reactions (PCRs) provided for all infants, one PCR was reported positive 2 days after birth,
whereas this infant 10 min after birth, immediately after routine procedures, due to positive mother’s
PCR was isolated from the operating room. However, all of the infant’s clinical symptoms were normal
during the 3‑day hospital stay for routine postpartum care. Twenty‑eight days after birth, the baby
was reevaluated for clinical, laboratory, and chest X‑ray symptoms, all of which were normal. The
PCR of other neonates was negative, and five intubated neonates, two twin, and two single died, and
the other neonates were discharged. In evaluating the clinical records of mothers of these infants,
the mean age is 30 years, and the average gestational age is 35 weeks, 32 cases of caesarean
section, and 10 cases of normal delivery.
CONCLUSION: We describe epidemiological data, demographics, signs and symptoms on
admission, laboratory results, comorbidities, infection COVID‑19 in the mothers and neonates,
chest radiography and computed tomography findings, treatment received for COVID‑19, and
clinical maternal, fetal, and neonatal outcomes. Due to the fact that the study population is
small consist of 42 mothers with COVID‑19 infection, among all PCR samples from infants
born to COVID‑19 positive mothers, the PCR result of one case was positive, and the rest of
was negative. Therefore, vertical transmission of COVID‑19 through the placenta to the fetus
cannot be confirmed or denied, nor can the COVID‑19 confirmed or denied the baby’s postnatal
complication during pregnancy.

Abstract BACKGROUND: Prenatal education provides opportunities for health promotion of healthy behaviors
and risk reduction. Quality and coherence with prenatal health promotion best practices depend on
an individual class instructor. The objective of our study was to document the experiences, practices,
and perceptions of our diverse Ottawa, Canada community of prenatal educators.
MATERIALS AND METHODS: In this quantitative, mixed methods e‑survey conducted in Ottawa,
Canada, prenatal educators were asked to describe their prenatal class settings, delivery formats,
content, perceptions of pregnant women, and recommendations. Data were analyzed by descriptive
statistics and thematic content analysis.
RESULTS: Respondents included public health nurses and a diverse group of “allied childbirth
educators” (ACE). Topics related to pregnancy, labor, and postpartum issues were well addressed;
however, established and emerging risks to pregnancy were omitted. Nurses were more likely to
discuss lifestyle risks to pregnancy and general prenatal health promotion, whereas ACE respondents
emphasized informed consent and individualized counseling. Women marginalized by social exclusion
including Indigenous women, immigrants, and women with disabilities were perceived as missing
from prenatal educational settings.
CONCLUSIONS: Heterogeneity of prenatal education provides opportunities for collaboration;
however, established and emerging risk factors to pregnancy are neglected topics. Addressing the
needs of diverse communities of pregnant women requires timely, evidence‑based, inclusive, and
culturally safe delivery of prenatal health promotion.