Journal of Education and Health Promotion

Abstract BACKGROUND: Pregnant women are classified as one of the vulnerable groups. Physiological and
psychological changes during pregnancy predispose them to serious psychiatric disorders; if not
identified and treated in time, it can have a negative and long‑term impact on mental health. The aim
of this study was to determine the effect of cognitive–behavioral counseling of pregnant women with
the presence of a spouse on the level of stress, anxiety, and postpartum depression.
MATERIALS AND METHODS: The present study is a clinical trial that was performed on 40 pregnant
women with a gestational age of 32–28 weeks (20 in the intervention group, 20 in the control group)
who were randomly assigned to the intervention group and the control group according to the inclusion
criteria. Cognitive–behavioral group counseling in the presence of spouses was performed by the
midwife and under the supervision of a psychologist, in eight sessions, each session lasting 90 min,
once a week for the intervention group. The control group received routine care and a counseling
session. Data collection tools were demographic information questionnaire and Depression–Anxiety–
Stress Scale 21, which were completed before the intervention, immediately after the intervention,
and on the 14th day after delivery in both groups. Data analysis was performed using statistical tests,
independent t‑test, repeated measures test, Bonferroni post hoc test, and Kolmogorov–Smirnov test.
RESULTS: The results of this study showed that the mean scores of stress, anxiety, and depression
in the two groups in the preintervention stage were not significantly different (P < 0.05), but in the
postintervention stage and follow‑up, the mean scores of stress (P < 0.001), depression (P = 0.010),
and anxiety (P = 0.029) in the intervention group were significantly reduced compared to the control
group.
CONCLUSION: According to the research findings, cognitive–behavioral group counseling can be
effective as an approach in improving the symptoms of stress, anxiety, and depression in pregnant
women. Therefore, it is necessary to plan properly to use this counseling approach to manage stress,
anxiety, and depression in women during pregnancy.

Abstract BACKGROUND: Preterm birth (PTB) is one of the most important factors that increase the risk of
chronic diseases and postpartum death in infants. The aim of this study was to determine the maternal
factors that affect the birth of preterm infants in the city of Bandar Abbas.
MATERIALS AND METHODS: This is a case–control study that was performed on 400 preterm
infants. Sampling was done by a simple method, and information was gathered by interviewing the
mothers and their medical records. Data were collected by SPSS software version 16. To compare
risk factors in the two groups, conditional logistic regression was used, and P < 0.05 was considered
statistically significant.
RESULTS: Results showed that factors such as type of delivery (odds ratio [OR] = 3.584, 95%
confidence interval [CI]: 1.981–6.485), preeclampsia (OR = 2.688, 95% CI: 1.164–6.207), history
of PTB (OR = 4.171, 95% CI: 1.483–11.728), premature rupture of membranes (OR = 3.273,
95% CI: 1.745–6.137), care during prenatal (OR = 0.334, 95% CI: 0.159–0.701), placental
abruption (OR = 3.209, 95% CI: 1.209–8.519), placenta previa (OR = 9.333, 95% CI: 2.086–41.770),
and cervical insufficiency (OR = 11, 95% CI: 1.381–87.641) were independent risk factors of preterm
infant birth.
CONCLUSIONS: The PTB risk is higher for women with cervical insufficiency, history of placenta
previa, and history of preterm. Early recognition and management of these high‑risk conditions among
pregnant women may lead to a reduction in PTB rates.

Abstract BACKGROUND: Pregnancy alone is associated with many anxieties and worries for many women.
Prenatal diagnosis of fetal malformations is one of the most important anxious events for women.
Increasing knowledge empowers the person to identify the important issues and by increasing
understanding, creates a positive attitude in people. Therefore, the aim of this study was to investigate
the effect of education on the level of anxiety of pregnant mothers before invasive screening for fetal
abnormalities (amniocentesis).
MATERIALS AND METHODS : This is a quasi‑experimental study with two parallel designs in three
stages: Pretest (before intervention), posttest (after intervention), and after amniocentesis. This study
was performed on 80 pregnant women candidates for amniocentesis (40 pregnant women in the
control group and 40 pregnant women in the intervention group) referred to the perinatology clinic in
Yazd in 2020. Data collection tools were demographic and midwifery questionnaires and Spiel Berger
anxiety questionnaires. In the experimental group, the intervention was performed as group training
for 90 min immediately before amniocentesis. In the control group, only routine procedures (brief
description by a perinatologist during amniocentesis) were performed. SPSS software version 16
was used to analyze the data.
RESULTS: The mean age of the research units was 67/5 ± 5/33 years. The results of Mann–Whitney
intergroup test showed that the mean scores of overt anxiety before the intervention between the
control and intervention groups were not significant (P < 0.014) but were significant after training and
after amniocenter (P < 0.001). Furthermore, the results of Mann–Whitney group test showed that
the mean scores of overt anxiety in the intervention group before and after training were significant
(P < 0.001). Furthermore, the results of the control group showed significant results (P < 0.001). The
results of the independent t‑test showed that the mean scores of latent anxiety before the intervention
between the control and intervention groups were not significant (P < 0.194) but were significant
after the training (P < 0.57) but The results were not significant after amniocentesis (P < 0.216).
Furthermore, the results of paired t‑test within the group showed that the mean scores of overt
anxiety in the intervention group before and after training was significant (P < 0.001). Furthermore,
the results of the control group showed significant results (P < 0.001).
CONCLUSION: The findings of the present study indicate the positive effect of education on anxiety of
pregnant women candidates for amniocentesis. The results also show the important role of education
on the psychological dimension of high‑risk pregnant women in relation to the consequences of
pregnancy and childbirth. According to the research results, it seems that education affects the
cognitive system and information processing by increasing people’s awareness of the amniocentesis
process and its consequences.

Abstract INTRODUCTION: Health promotion is one of the most important aspects in pregnancy, and
health‑promoting behaviors are one of the major determinants of health under the influence of various
factors. This study aimed to determine the association between social support and psychological
factors with health‑promoting behaviors in pregnant women.
MATERIALS AND METHODS: This cross‑sectional was performed on 375 pregnant women when
they had 24–28 weeks in Ilam, October 2018 to May 2019. Two‑stage cluster sampling was performed
after checking the inclusion criteria. Data collection tools consisted of four questionnaires that were
completed in self‑report form. The collected data were analyzed by the descriptive and inferential
tests with the SPSS software version 19.
RESULTS: The mean score of health‑promoting behaviors was 139.87 (21.26) and self‑healing and
physical activity had the highest and the lowest mean 27.67 (4.84) and 16.29 (4.84), respectively.
Linear regression analysis showed a significant difference between different level of stress, anxiety,
depression, and social support with health‑promoting behaviors (P < 0.001). The results showed
that one‑point increase in the score of stress, anxiety, and depression led to the 2.2%, 6.1%, and
24.1% reduction of health‑promoting behaviors, respectively, and one‑point score increase in social
support resulted in 40% increase in health‑promoting behaviors (P < 0.001).
CONCLUSION: A negative association was found between psychological factors and a positive
relationship with health‑promoting behaviors. Although perceived moderate health promotion
behaviors and perceived social support were moderate, they did not have a good status in terms of
psychological factors. Given awareness of the issues under study in each region is essential and
planning to improve stress, anxiety, and depression, as well as promoting and correcting inappropriate
behaviors through planned interventions are required.

Abstract INTRODUCTION: Abortion is one of the most common complications of early pregnancy, which
emerges as a physically and mentally devastating experience. Due to the prevalence and importance
of postabortion mental health problems and their adverse effects on subsequent pregnancies, some
interventions should be made to reduce the resultant anxiety and depression. The present study
aimed to determine the effect of self‑care education on anxiety and depression among pregnant
women with a history of spontaneous abortion.
METHODS: This randomized quasi‑experimental study was performed on ninety pregnant women
with a history of spontaneous abortion who referred to health centers in Zahedan in 2019. The
samples were selected by convenience sampling method and randomly assigned to two intervention
and control groups. Between 6 and 16 weeks of gestation, the participants in the intervention group
received four sessions of 60‑min self‑care training over 2 weeks. On the other hand, the control
group received routine pregnancy care. Data collection tools included a demographic and fertility
evaluation questionnaire, a 6‑item short‑form of the state scale of the Spielberger State‑Trait Anxiety
Inventory, and a short form of Beck Depression Inventory. Posttest was performed 4 weeks after
the end of the intervention. The data were analyzed in SPSS software (version 21) using statistical
tests of independent t‑pair, paired t‑pair, Chi‑square, and Fisher’s exact test.
RESULTS: Based on the obtained results, there was no significant difference between the two
groups in terms of anxiety and depression scores before the intervention. Nonetheless, after the
intervention, the mean scores of anxiety and depression in the intervention group were calculated
at 7.31 ± 1.31 and 4.71 ± 1.90, respectively. However, these scores were reported as 1.87 ± 13.46
and 9.31 ± 1.59 in the control group, respectively (P = 0.0001).
CONCLUSION: As evidenced by the obtained results, self‑care education is effective in the reduction
of anxiety and depression in pregnant women with a history of spontaneous abortion. Therefore,
health professionals and health‑care providers should enrich prenatal care programs with these
training sessions and provide women with peace of mind and comfort during pregnancy.

Abstract BACKGROUND: Health literacy is the capacity to acquire, process, and understand basic information
and services necessary for appropriate health decisions. Given the importance of health literacy in
women, the aim of the present study was to determine the effect of health literacy level on improving
the quality of care during pregnancy in pregnant women.
MATERIALS AND METHODS: The present study was a cross‑sectional analytical study. In this
study, 130 women referred to Yazd health centers were examined. Health literacy questionnaires
and a researcher‑made checklist of the quality of pregnancy care were used to gather information.
The researcher‑made checklist of the quality of pregnancy care was in accordance with the standard
protocol of the Ministry of Health and Medical Education, entitled Integrated Health Care for Pregnant
Mothers, which was validated and reliable. SPSS statistical software version 19 and t‑test and ANOVA
statistical tests were used to analyze the data.
RESULTS: According to the findings, the average score of health literacy in pregnant women was
74.09, which showed that the level of health literacy was in the marginal or border range. People
with higher health literacy received significantly more prenatal counseling than other women and
had a planned pregnancy (P = 0.04).
CONCLUSION: The level of health literacy in pregnant women is unfavorable. Given that the high
level of health literacy in women in society can lead to an increase in the quality of pregnancy care, so
to increase health literacy in women, it is recommended that regular training in society by health‑care
providers be given more attention.

Abstract BACKGROUND: In the postpartum period, changes in sexual desire and marital satisfaction can be
seen. Learning and giving enough information on changes in pregnancy and postpartum can help
to increase marital satisfaction. The purpose of this study was to determine the effect of prenatal
training on the level of postpartum marital satisfaction in nulliparous women.
METHODS: This study is a semi‑experimental two‑group study in which 150 nulliparous women were
divided into two groups: control and intervention groups. The samples into intervention group received
routine prenatal care and eight sessions of prenatal education with a training package (educational
pamphlet on sexual health and sexual issues and an educational CD on pregnancy and pelvic
exercises), and the control group received only routine prenatal care along with a pregnancy education
pamphlet. Marital satisfaction was measured before intervention during pregnancy and 3 months
after delivery (after intervention) using the ENRICH Marital Satisfaction Scale. Data were analyzed
using t‑test, paired t‑test, Mann–Whitney, and Chi‑square test.
RESULTS: There was no significant difference in demographic and obstetric variables and pregnancy
status between the two intervention and control groups (P > 0.05). There was no significant difference
in marital satisfaction during pregnancy between the two groups (before intervention) (P > 0.05).
However, there was a significant difference in the level of postpartum marital satisfaction in the
intervention group (P < 0/05). So that, the average marital satisfaction is increased from 52.2 to 64.6.
CONCLUSION: The results of this study show that eight sessions of prenatal education class with a
training package (educational pamphlet on sexual health and sexuality and training CD of prenatal
and pelvic floor exercise) can improve postpartum marital satisfaction in women.

Abstract INTRODUCTION: Many women refuse to exercise during pregnancy due to lack of awareness and
not receiving training. The aim of this study was to investigate and compare the effect of group and
telemedicine education on exercise during pregnancy by using the health belief model (HBM).
MATERIALS AND METHODS: This quasi-experimental study was carried out in 2019 in Zahedan,
and a total of 135 pregnant women participated in it. Samples were randomly assigned to the following
three groups: group training (n = 45), telemedicine (n = 45), and control (n = 45). Group training was
presented in three sessions, and the telemedicine group received the educational content through
mobile applications. The samples completed the HBM questionnaire before and 6 weeks after the
intervention. In addition, within 6 weeks after the intervention, they completed the exercise activity
schedule. SPSS software Ver. 16 (IBM Corp, Armonk, NY, USA) was used for analysis, and data
were analyzed by ANOVA, Tukey’s post-hoc test, Kruskal–Wallis test, and Mann–Whitney test.
RESULTS: After intervention, the scores of HBM constructs and exercise levels in group training,
telemedicine group, and control group, respectively, were as follows: perceived susceptibility
25.91 ± 3.24, 25.51 ± 1.97, and 22.55 ± 3.78; perceived severity 27.48 ± 2.27, 25.13 ± 2.29, and
22.51  ±  3.88; perceived benefits 27.28  ±  2.97, 25.68  ±  3, and 22.8  ±  3.05; perceived barriers
10.69 ± 2.69, 10.66 ± 3.19, and 14.17 ± 3.14; cues to action 24.71 ± 4.35, 23.9 ± 2.48, and
22.84  ±  3.02; self-efficacy 26.17  ±  3.05, 25.2  ±  2.82, and 22.51  ±  3.38; and exercise levels
70.99 ± 20.43, 56.51 ± 21.99, and 37.62 ± 29.66. Group training and telemedicine led to significant
improvement in all HBM constructs and exercise levels (P < 0.05, P < 0.0001, and P = 0.003,
respectively). Group training provided more improvement than telemedicine in the scores of perceived
severity (P < 0.0001), perceived benefits (P = 0.001), cues to action (P = 0.02), and mean exercise
time (P = 0.001).
CONCLUSION: The results of this study showed that the HBM is a proper model for exercise
education in pregnant women. It is recommended to use HBM as a group training and telehealth in
promoting the rate of exercise in pregnant women.

Abstract BACKGROUND AND AIM: Given the prevalence of novel coronavirus disease 2019 (COVID‑19)
and the lack of information on coronavirus and pregnancy, the purpose of this study was to evaluate
the association of COVID‑19 and perinatal outcomes in pregnant women.
MATERIALS AND METHODS: In the present review article, the search process was conducted on
English and Persian scientific databases of PubMed, Scopus, Google Scholar, Magiran, Irandoc,
Iranmedx, and SID as well as the websites of international organizations of World Health Organization
and Centers for Disease Control and Prevention using the main keywords of “Pregnancy,” “Perinatal
outcomes,” “Coronavirus,” “COVID‑19,” “MERS‑CoV,” “MERS,” “SARS‑CoV‑2,” and “SARS‑CoV‑1”
and their Persian‑equivalent keywords from inception until March 16 2020.
RESULTS: The findings of studies on mothers with COVID‑19 were limited, and insufficient information
is available on the adverse pregnancy outcomes in pregnant women with COVID‑19. In cases of
infection with other coronaviruses such as Middle East respiratory syndrome and severe acute
respiratory syndrome during pregnancy, there have been reports on adverse pregnancy outcomes
such as miscarriage, stillbirth, preterm labor, low birth weight, and congenital malformations following
high fever in the first trimester.
CONCLUSION: Pregnant women may be more susceptible to viral respiratory infections, including
COVID‑19, due to immunological and physiological changes. Therefore, pregnant women should
take routine preventive measures, such as washing their hands frequently and avoiding contact with
infected people, to prevent infection.

Abstract INTRODUCTION: Maternal attachment to the fetus is an emotional bond and the unique relationship
of the pregnant woman to the fetus. Attachment is an important predictor of mental health. One of
the psychological factors affecting mental health is resilience and hope. The purpose of this study
was to determine the relationship between hope and resilience with promoting maternal attachment
to the fetus during pregnancy.
METHODS: This is a descriptive correlational study performed on 386 pregnant women referred to
community health centers in Isfahan‑Iran. The research instruments were standard questionnaires
of Hope Snyder, Conor and Davidson Resilience, and maternal attachment to the fetus of Cranley.
Data were analyzed using descriptive statistics and Pearson’s correlation test.
RESULTS: The results showed that there is no significant relationship between the overall score
of maternal attachment to the fetus and the total score of hope (P = 0.73). The overall score of
maternal attachment to the fetus was positively and significantly correlated with hope subscales,
including thinking (P = 0.004) and path (P = 0.047). The overall score of maternal attachment to the
fetus was positively and significantly correlated with the overall score of resilience (P = 0.03). There
was a correlation between the dimensions of maternal attachment to the fetus, including interaction
with the fetus (P = 0.003) and self‑sacrifice (P = 0.015). Maternal role acceptance (P = 0.001) was
positively and significantly correlated with hope thinking subscale. Self‑sacrifice (P = 0.027) and
differentiation between self and fetus (P = 0.035) were positively and positively correlated with hope
path subscales. Self‑sacrifice (P = 0.03) and attribution to fetus (P = 0.001) had a significant positive
relationship with resilience.
CONCLUSION: The results of this study showed that hope and resiliency are positively and
significantly associated with maternal attachment to the fetus during pregnancy. Hope and resiliency
are positively and significantly associated with maternal attachment to the fetus, thus increasing the
expectation of pregnant mothers to increase their attachment to their fetus. As a result, they are paying
more attention to prenatal care, which can guarantee the health of their mothers and their babies.

Abstract INTRODUCTION: Mental health is very important during pregnancy, and perfectionism, body image,
and eating disorder are three important factors in mental health. Given that eating disorders are very
dangerous in pregnancy, the aim of this study was to determine the relationship between perfectionism
and body image with eating disorder in pregnancy.
METHODS: This descriptive study was performed on 200 pregnant women referred to Isfahan Health
Centers in 2017. The research units, if met the inclusion criteria, completed the Eating Attitudes
Questionnaire, Multidimensional Relationships of their Body Questionnaire, and Perfectionism
Questionnaire. Finally, the data were analyzed by SPSS software version 22, with a significance
level of 0.05.
RESULTS: The results showed that there was a significant negative relationship between positive
perfectionism with symptoms of eating disorder, anorexia nervosa, and nervous longing to eat.
There was a significant positive correlation between negative perfectionism with symptoms of eating
disorder, anorexia nervosa, and nervous longing to eat. The results also showed a significant negative
relationship between body image and its dimensions with symptoms of eating disorder, anorexia
nervosa, and neurasthenia.
CONCLUSION: Perfectionism and body image and its dimensions are psychological problems related
to eating disorder in pregnancy. For this reason, it seems that taking classes for pregnant women
and their spouses can reduce the incidence of this disorder.

Abstract INTRODUCTION: Stress in pregnancy can have a negative effect on mother and fetus and at last
on childhood. The use of stress reduction techniques in pregnant women has an effective role in
the reduction of the mother and child’s mental problems. This study aimed at determining the effect
of static immersion and relaxing the pregnant women in water on stress, participating in preparation
classes for childbirth in Isfahan, Iran, 2017.
METHODS: The present study was a semi‑experimental and had pre‑ and post‑test
one on 55 pregnant women aged 20–30 weeks (20 test group and 35 control group)
participating in the preparation classes for delivery by available sampling method selected in
2017 and their stress level was assessed by depression, anxiety, and stress scale questionnaire.
Then, they were divided into test and control groups. In the control group, no intervention was
performed, and in the test group, static immersion and calming in water was done in Isfahan
University’s 9‑Dey Pool. To analyze the data, paired t‑test, Chi‑square t‑test, and independent
t‑test were used.
RESULTS: In this study, stress in the test group decreased after the intervention, so that the mean
stress score decreased from 20.20 to 16.67 (P < 0.05). Of course, the stress level declined in the
control group, but in the control group, it decreased significantly.
CONCLUSION: Based on the findings of the present study, static immersion and calming in water
are considered as reducing women’s stress intervention in improving pregnancy period and are
therefore recommended to be included in the sanitary system.

Abstract BACKGROUND: Preterm low birth weight (PLBW) is a leading perinatal problem in developing
countries. PLBW is considered as a leading cause of neonatal death in the 1st year of life, with problems
in childhood and adulthood. Several studies have suggested a possible relationship between PLBW
and periodontal status of the expectant mothers. The present study was conducted to determine the
association between the maternal periodontitis and the low birth weight (BW) of the babies.
MATERIALS AND METHODS: This study consisted of 200 primipara mothers ranging between
18 and 35 years old, with a mean age of 23.96 years. The mothers were categorized based on the
weight of the infants as cases (BW <2500 g) and as controls (BW ≥2500 g). Age, mean weight,
height, body mass index, and periodontal status of the mothers as well as weight of the babies were
recorded. Periodontal parameters were assessed using the community periodontal index (CPI). The
data were recorded, analyzed, and statistically compared using the Chi‑square test (χ2
).
RESULTS: BW of the babies was regressed against CPI. Periodontitis was significantly associated
with decrease in BW of the babies (P < 0.0001).
CONCLUSION: Our findings showed an association of maternal periodontal disease with PLBW that
emphasizes to promote good oral hygiene of the expectant mothers during routine prenatal visits.

Abstract INTRODUCTION: The healthcare program has opponents and supporters with its multiple policies
and also its difficult implementation, which requires that its barriers and problems be addressed
comprehensively and extensively. This study was conducted aimed to determine the service
provision challenges by healthcare providers, from their point of view, in selected comprehensive
health centers of Isfahan.
MATERIALS AND METHODS: The present study is a descriptive‑analytic one. One‑hundred
and ninety‑seven healthcare providers were selected by census sampling method from the
population of female healthcare providers in Isfahan comprehensive health centers in 2017. The
data collection tool was a researcher‑made questionnaire in the field of individual–professional,
managerial–organizational, and executive challenges. Data analysis was done by repeated measures
ANOVA and post hoc test.
RESULTS: The findings indicated that there was a significant difference between the mean score
of individual–professional, managerial–organizational, and executive challenges (P < 0.001) from
the point of view of healthcare providers. According to least significant difference post hoc test, the
mean score of individual challenges was significantly lower than that of managerial and executive
challenges (P < 0.001). However, there was no significant difference between the mean score of
managerial–organizational and executive challenges (P = 0.46).
CONCLUSION: Based on the results, healthcare providers have put forward several challenges during
the implementation of the healthcare program. Meanwhile, executive and managerial challenges
have been considered more than individual challenges. Considering that this could lead to improper
service provision to the clients, the role of policymakers in this program to remove obstacles and to
provide satisfaction to healthcare providers is emphasized.

Abstract INTRODUCTION: Mental health is one of the focuses of the health assessment of different
communities and plays an important role in ensuring the dynamism and efficiency of each community.
Pregnancy is one of the most sensitive periods, in which mental health is effective. The mental health
of individuals is the result of the interaction of cognitive‑emotional ordering strategies and proper
evaluation of stressful situations. The aim of this study was to determine the relationship between
cognitive emotion regulation and the health of pregnant women.
MATERIALS AND METHODS: This is a descriptive and cross‑sectional study that was carried out on
200 pregnant women who were covered by Navab, Amir Hamzeh and Motahari centers in Isfahan in
2017 by available sampling method. The instrument was the Beck Depression Inventory, Goldenberg
Health, and Emotional Cognitive Order. Finally, the data were analyzed using the SPSS software.
RESULTS: The mean age of pregnant mothers participating in the study was 26.66 ±6.09 years. The results
of data analysis showed a significant positive correlation in relation to blaming others and disaster with
physical health, blaming others and rumination and catastrophes with anxiety, disaster with social health,
blaming others and rumination and catastrophes with depression, and also blaming others and rumination,
catastrophizing, and positive re‑focusing have a significant positive correlation with total health score.
CONCLUSION: Regarding the relationship between mental health and cognitive dysmenorrhea
during pregnancy, pregnant women carers can help with pregnant women by conducting educational
programs on health promotion and strive to maintain mental health and improve their quality of life.
Consequently, they will ensure the mental health of their future children.

Abstract PURPOSE: Postpartum period is a critical interval in which the woman is under risk for psychiatric
disorders including postpartum depression (PD). This study was performed to investigate the impact
of the mode of delivery on the occurrence of PD in primiparous mothers.
MATERIALS AND METHODS: This correlational study was performed on 244 primiparous
women (aged 15–49 years) in 17 primary health‑care centers. Sociodemographic, obstetric, and
PD‑related data were gathered using questionnaires and the Edinburgh Postnatal Depression
Scale (EPDS) on the 1st and 3rd months after delivery. The questionnaires were administered to all
primiparous mothers who were registered to the relevant health-care center. Questionnaires were
administered by the researcher for 25–30 min with face-to-face interview technique.
RESULTS: Comparison of EPDS scores on the 1st and 3rd months indicated that there was a
remarkable decline over time (Z = 11.112, P = 0.001). There was an inverse association between
educational level and EPDS scores on the 3rd month (P = 0.037). On the other hand, no significant
relationship was detected between age groups, occupation, income, place of accommodation, and
EPDS scores. Evaluation of the relationship between obstetric features and EPDS scores revealed
that desired and performed modes of delivery, induction, episiotomy, and spinal anesthesia were
not linked with EPDS scores. The postpartum behavior (2=10.315; P = 0.035) and feeding method
of infants (2 = 6.109; P = 0.013) were associated with EPDS scores on the 1st month, but not with
EPDS scores on the 3rd month.
CONCLUSION: Effective measures must be established for early recognition of factors affecting the
occurrence of PD. Health planners and policymakers must spend their efforts for promotion of the
knowledge and attitudes of mothers during pregnancy. Identification of factors for PD necessitates
implementation of multicentric, controlled trials on larger series.

Abstract BACKGROUND AND AIM: Mental health issues including depression and anxiety are common
in pregnancy worldwide. This study aimed to identify factors associated with mental disorders in a
sample of Iranian pregnant women.
MATERIALS AND METHODS: A cross‑sectional study was conducted among pregnant women
referred to a prenatal‑care clinic in an urban area, Isfahan, Iran. The questionnaires in this study
included the General Health Questionnaire and additional structured questionnaires exploring
sociodemographic, obstetric, and economic risk factors and empowerment for decision‑making
regarding pregnancy, parenting, financial authority, trust, and confidence in health‑care staff.
Regression analysis was performed to assess the impact of the number of variables on the likelihood
of the presence of mental health problems.
RESULTS: Overall, 54.2% and 11.7% of the women had anxiety and depression, respectively. No
statistically significant associations were reported between anxiety and depression and obstetric
characteristics such as gestational age, parity, abortion, previous infertility, unwanted pregnancy,
and the screening test results . According to the logistic regression analysis, the predictors of
depression and anxiety were acknowledging psychological changes in pregnancy and empowerment
for decision‑making regarding pregnancy and parenting and financial authority (P < 0.05).
CONCLUSIONS: probably, women’s empowerment on becoming aware of psychological changes
during pregnancy and making decisions on pregnancy, parenting, and financial authority is the factor
affecting the mental health of pregnant women.

Abstract INTRODUCTION: Childbirth fear is one of the major problems during pregnancy and postpartum,
and it assesses the sense of management coherence in stress. Therefore, the present study was
conducted to compare the association between the sense of coherence and childbirth fear in high‑risk
and low‑risk pregnant women.
MATERIALS AND METHODS: This was a cross‑sectional correlation study performed on 440
low‑risk and high‑risk pregnant women referred to health centers in Isfahan in 2016. Sampling was
carried out in several stages and clustered and accessible. The data gathering tool was Sense of
Coherence and Fear of Childbirth Questionnaires.
RESULTS: The results showed that in high‑risk pregnant women, the mean score of the sense of
coherence was 108.23 and the fear of delivery was 41.7, and in low‑risk pregnant women, the sense
of integrity and fear of delivery were 19.109 and 42.25, respectively. In addition, the results of t‑test
showed that there is no significant relationship between the fear of delivery in high‑risk and low‑risk
pregnant women (P = 0.056), while there is a significant relationship between sense of coherence
score in high‑risk and low‑risk pregnant women (P = 0.02).
CONCLUSION: Having the desired level of success, happiness, well‑being, ability to cope with stress
and overcoming psychological crisis, and pleasant social relationships can increase the sense of
coherence in pregnant mothers.

Abstract BACKGROUND: If anxiety and depression do not detect in pregnant women, they may cause
complications for the mother, child, and family, including postpartum depression. With regard to the
administrative capability of relaxation in health centers, this study was conducted to determine the
effect of progressive muscle relaxation and guided imagery on stress, anxiety, and depression in
pregnant women.
MATERIALS AND METHODS: This randomized clinical trial was conducted on pregnant women in
the city of Kashan at 28–36 weeks. At the onset of the study, demographic questionnaire, Edinburgh
Depression Scale, and Depression, Anxiety, and Stress Scale‑21 (DASS‑21) were completed.
Providing obtaining score of mild‑to‑moderate in the stress, anxiety, and depression scale and score
of 10 or higher in Edinburgh Depression Scale, individuals were divided randomized to the intervention
group (n = 33) and control group (n = 33). DASS‑21 was again completed in the 4th–7th weeks of
beginning of the study by all women.
RESULTS: Analysis of variance with repeated measures indicated significant differences in mean
of scores of stress, anxiety, and depression at three different times in relaxation group (P < 0.05)
whereas found no significant differences in the mean of scores of stress, anxiety, and depression
in the control group.
CONCLUSIONS: In this study, relaxation could reduce stress, anxiety, and depression in pregnant
women during six sessions. Due to the simplicity and low cost of this technique, it can be used to
reduce stress and anxiety in pregnant women and improve pregnancy outcomes.

Abstract BACKGROUND: The oral health of pregnant females needs attention, especially in developing countries
like India where oral checkup and care is not considered to be a part of mandatory antenatal protocols.
OBJECTIVE: This study aimed to evaluate the oral health status of pregnant females in Central India
including the assessment of their knowledge, attitude, and awareness about oral health.
MATERIALS AND METHODS: The study population comprised of 320 pregnant females, and a
control group consisted of 103 age‑matched nonpregnant females. A cross‑sectional self‑reported
questionnaire‑based survey and clinical examination was conducted.
RESULTS: Out of 320, 192 (60%) pregnant females had some dental problem during pregnancy.
Community periodontal index (CPI) score for total pregnant females (2.16) was significantly higher
in comparison to control group (1.29). Nearly 72.81% of pregnant females had never attended the
dentist. Trimester‑wise comparison showed time‑dependent increase in CPI score. Low educational
status, older age, earlier issues, poor hygiene habits, and tobacco use showed a direct effect on
compromised oral health.
CONCLUSION: The study highlights the need of interaction between dental practitioners and
gynecologists including routine dental checkup during antenatal visits of pregnant females as essential.

Abstract CONTEXT: Fresh Bachelor of Medicine and Bachelor of Surgery graduates (FMGs) are responsible
for the majority of prescription errors and irrational use of medicines. Little research has explored
their knowledge on rational prescribing practices.
AIMS: The present study aimed to evaluate the awareness of rational use of medicines (RUMs)
among the FMGs.
SETTINGS AND DESIGN: A multicentric, cross‑sectional, and questionnaire‑based study was
conducted among 308 FMGs during the internship orientation program.
SUBJECTS AND METHODS: The structured and prevalidated questionnaire consisted of
35 statements on important aspects of RUM.
STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 24.0 at 95% level of
significance with Fisher’s exact test.
RESULTS: Nearly 31% of FMGs did not know that the generic drugs are equally efficacious as branded
drugs whereas 53% were in support of pregnant female should not consume any drug. Nearly 58% of
FMGs were confused about deciding the dose in children and 18% were in favor of using antibiotics
in common cold. Almost 55% of FMGs were disagree for adjusting the dose of antidiabetic drugs by
patient depending on the meal taken whereas 12% were not aware of the importance of compliance
of antihypertensive drugs and 40% were supporting the safety of fruits in chronic renal disease. The
FMG from government colleges answered more correctly than that of the private colleges.
CONCLUSIONS: The awareness of RUM among FMG is not satisfactory, and also there is a gap in
its implementation. Thus, they should be supervised during the initial phase of their medical practice.

Abstract INTRODUCTION: Pregnancy is one of the high‑risk periods for women’s health that the lack of
attention to healthy behaviors such as weight control behaviors can lead to adverse consequences
on the health of women and also the fetus. Therefore, the aim of this paper was to explore the
determinants of weight control self‑efficacy among pregnant women using Health Belief Model (HBM).
MATERIALS AND METHODS: In this cross‑sectional study were enrolled 202 pregnant women
referring to Health Care Center in Isfahan city, Iran. Sampling method was multistage random.
A researcher‑made instrument based on HBM structures was used after confirming the valid and
reliable. Data were analyzed by software SPSS 21 and descriptive statistics were represented
with (frequency, mean and standard deviation) and analytical (Pearson correlation, independent t
and liner regression) at the significant level of <0.05.
RESULTS: The average age of participants was 27.80 ± 5.08. HBM structures were able explained
31% of variance of weight control self‑efficacy. Also, of the studied structures, perceived benefits,
perceived barriers were statistically significant predictors of weight control self‑efficacy, within which
perceived barriers (β = 0.391) was the most significant predictor.
CONCLUSION: The findings of current study showed that the HBM model could be as a suitable
framework to identify effective factors for designing educational intervention to improve weight control
behaviors among pregnant women.

Abstract BACKGROUND: The positive effects of physical activities during pregnancy are totally recognized
but due to lack of knowledge and negative aspect toward it, physical activities decrease throughout
the pregnancy period. To find the appropriate model to enhance physical activity during pregnancy,
the education that are focused on health belief constructs about physical activity during pregnancy,
were assessed.
MATERIALS AND METHODS: This was a semi‑experimental study conducted on 90 pregnant
women in their first trimester that were divided into two groups of control and intervention.
After assessing health belief model (HBM) constructs and measuring the duration of severe/
moderate‑intensity) physical activity through a questionnaire, participants were divided into
two groups of 45. The intervention group received education about physical activity based on
HBM and the control group received dental health education. In the second trimester again, the
constructs of HBM and the duration of physical activities were evaluated. Significant level was
set at P < 0.05.
RESULTS: Data analysis showed that level of perceived susceptibility/severity and perceived
benefits and also the level of appealing physical activity (P < 0.05), had a significant increase in
the intervention group after the education, but the mean of the severe/moderate‑intensity physical
activity with did not rise to 150 min/week.
CONCLUSION: Study results showed that education based on HBM could lead to an increase in
physical activity during pregnancy by increasing the level of health beliefs in pregnant women, but
this increase does not reach the adequate level.

Abstract Introduction: The rate of caesarean delivery is increasing worldwide. Maternal beliefs may be
influential on the mode of delivery. This study aimed to validate pregnant women’s preferences
for mode of delivery questionnaire among pregnant women. Materials and Methods: This was
a cross‑sectional study which was done in Ahvaz Public and Private Health Care Centers. A total
of 342 low‑risk pregnant women were included in a study conducted in spring 2011 in Ahvaz,
Iran. After careful consideration and performing content and face validity, a 62‑item measure
was developed and subjects completed the questionnaire. Reliability was estimated using
internal consistency and validity was assessed by performing face, content and structure and
discriminate validity. Data were analyzed using explanatory factor analysis, t‑test, and correlations
in SPSS 16. Results: The findings of content and face validity showed almost perfect results for
both content validity ratio = 1 and content validity index = 1. The explanatory factor analysis
indicated a 7‑subscale measure (Eigenvalue >1, factor loading >0.4), and discriminate validity
revealed satisfying results P < 0.05 for 6 out of 7 subscales. Internal consistency as measured
by the Cronbach’s alpha coefficient was acceptable for subscales. Conclusions: In general,
the findings suggest that this newly generated scale is a reliable and valid specific questionnaire
for assessing pregnant women’s preferences for mode of delivery. However, further studies are
needed to establish stronger psychometric properties for the questionnaire.

Abstract Background: Physical activity generally declines during pregnancy, but activity barriers during
this period are not well understood. The objective was to determine physical activity and some
relative factors in referred pregnant women. Materials and Methods: This cross‑sectional
study was carried on 384 in referred pregnant women to Isfahan Health Care Centers and
Shahid Beheshti Hospital in second stage sampling method in 2013. Demographic/prenatal
characteristics, physical activity (36Q) and prenatal life quality questionnaire (26Q) were
completed by participants. The statistical analysis was performed with various statistical tests
such as the t‑test, one‑way ANOVA, individual correlation coefficient, and linear regression
using SPSS statistical software (version 16). Results: Based on the findings, 98.7% (n = 378)
of pregnant women had low physical activity. Also, there were a correlation among physical
activity and parity, age, gestational age (P ≤ 0.005). Conclusion: Since physical activity is
recommended for the most of pregnant women, it is imperative to promote physical activity
between pregnant women and some intervention suggestions.