Document Type : Original Article
Authors
1 Obstetrics and Gynaecology, Mother and New Born Health Research Centre, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran
2 MSc Student in Midwifery Counselling, Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3 Associated Professor, Biostatistics and Epidemiology Department, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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.
Keywords
- Dolatian M, Mirabzadeh A, Forouzan AS, Sajjadi H, Majd HA,
Moafi F, et al. Correlation between self‑esteem and perceived
stress in pregnancy and ways to coping with stress. Pajoohandeh
J 2013;18:55‑148.
2. Khavari F, Golmakani N, Saki A, Aghamohammadian Serbaf H.
The relationship between prenatal coping strategies and irrational
beliefs in pregnant woman. J Midwifery Reproduct Health
2018;6:22‑1215.
3. Sarani A, Azhari S, Mazlom SR, Aghamohammadian Sherbaf H.
The relationship between psychological hardiness and coping
strategies during pregnancy. J Midwifery Reproduct Health
2015;3:17‑408.
4. kordi M, Riyazi S, Lotfalizadeh M, Shakeri M, Jafari Suny H.
Comparing the effects of Group and individual education on
worry and anxiety of pregnant women about fetal chromosomal
disorders screening tests. Iran J Obstetrics Gynecol Infertility
2015;18:1‑10.
5. Sanhal CY, Mendilcioglu I, Ozekinci M, Simsek M, Bozkurt S.
Comparison of pre‑procedural anxiety and depression scores for
patients undergoing chorion villus sampling and amniocentesis:
An alternative perspective on prenatal invasive techniques. Pak
J Med Sci 2015;31:1038‑42.
6. Saeidi R, Ziadi Lote Abadi M, Saeidi A, Gholami Robatsangi M.
The effeciiveness of mother infand interaction on infantile colic.
Iran J Neonatol 2014;44:37‑8.
7. GholamiM, Moallem SA, AfsharM, Etemad L, Karimi G. Maternal
exposure to silymarin leads to phatological changes in mouse
foetuses. Pharmacologyonline 2015;2:38‑43.
8. Karimi N, Rabiepour S, Khalkhali HR, Bahadori F. Evaluation
of anxiety and perceived stress in mothers undergoing
amniocentesis. The J Urmia Nurs Midwifery Fac 2017;15:300‑292.
9. Kindermann L, Traebert J, Nunes RD. Validation of an anxiety
scale for prenatal diagnostic procedures. Rev Saude Publica
2019;53:18.
10. Çift T. Assessment of anxiety in patients before and after
amniocentesis procedure. Age Journal of Clinical and Analytical
Medicine 2018;10:8.
11. Öhman SG, Saltvedt S, Grunewald C, Waldenström U. Does fetal
screening affect women’s worries about the health of their baby?
A randomized controlled trial of ultrasound screening for Down’s
syndrome versus routine ultrasound screening. Acta Obstetricia
et Gynecol Scandinavica 2004;83:40‑634.
12. Niromanesh S, Mousavi Darzikolaei N, Rahimi‑Shaarbaf F,
Shirazi M. Pregnancy outcome in amniocentesis and chorionic
villous sampling: Ten‑year report. Tehran Univ Med J TUMS
Publicat 2016;74:7‑400.
13. Kleinveld JH. Psychological Consequences of Prenatal Screening;
2008.
14. Klages K, Kundu S, Erlenwein J, Elsaesser M, Hillemanns P,
Scharf A, et al. Maternal anxiety and its correlation with pain
experience during chorion villus sampling and amniocentesis.
J Pain Res 2017;10:591‑600. - 15. Mohammadi E, Arshadi FK, Farzad V, Salehi M. Effectiveness
of acceptance and commitment therapy (ACT) on depression
in Women with marital conflicts. Int J Humanities Cultural
Studies2016;1:19‑108.
16. Brajenović‑Milić B, Martinac Dorcić T, Kuljanić K, Petrović O.
Stress and anxiety in relation to amniocentesis: Do women who
perceive their partners to be more involved in pregnancy feel less
stressed and anxious? Croat Med J 2010;51:137‑43.
17. Biesecker BB. The psychological well-being of pregnant women
undergoing prenatal testing and screening: A narrative literature
review. Hastings Center Rep 2019;49:S53‑S60.
18. Jepson RG, Hewison J, Thompson AG, Weller D. How should we
measure informed choice? The case of cancer screening. J Med
Ethics 2005;31:192‑6.
19. Prokop P, Lešková A, Kubiatko M, Diran C. Slovakian students’
knowledge of and attitudes toward biotechnology. Int J Sci Educ
2007;29:907‑895.
20. Navei M. Comparison of Two Methods of Teaching and Lecturing
Roles in Knowledge, Attitudes and Decisions about the Mode
of Delivery of Pregnant Women: Doctorate Thesis. Iran. Dental
School of Mashhad University of Medical Sciences; 2010.
21. Rabiee M, Jouhari Z, Pirasteh A. Knowledge of prenatal
screening, down syndrome, amniocentesis, and related factors
among iranian pregnant women: A cross‑sectional study. Int J
Community Based Nurs Midwifery 2019;7:150‑60.
22. Dahl K, Hvidman L, Jørgensen FS, Kesmodel US. Knowledge
of prenatal screening and psychological management of test
decisions. Ultrasound Obstet Gynecol 2011;38:152‑7.
23. Abedi M, Rasoli J, Rabiepour S, Saboory E. The relationship
between stress in pregnancy, and pregnancy outcomes:
A longitudinal study. J Urmia Nurs Midwifery Fac2017;14:81‑969.
24. Çakar M, Tari Kasnakoglu B, Ökem ZG, Okuducu Ü, Beksaç MS.
The effect of different information sources on the anxiety level
of pregnant women who underwent invasive prenatal testing.
J Matern Fetal Neonatal Med 2016;29:3843‑7.
25. de Leeuw RA, van der Horst SF, de Soet AM, van Hensbergen JP,
Bakker PC, Westerman M, et al. Digital vs. face-to-face information
provision in patient counselling for prenatal screening:
A noninferiority randomized controlled trial. Prenatal Diagnosis
2019;39:63‑556.
26. Kordi M, Riyazi S, Lotfalizade M, Shakeri MT, Suny HJ.
A comparison of face to face and group education on informed
choice and decisional conflict of pregnant women about screening
tests of fetal abnormalities. J Educ Health Promot 2018;7:6.
27. Amel Sh AA, Shida AH, Momtaz M, Abdelhaleem Z, Negm S.
Impact of a structured prenatal counseling on anxiety level
among women undergoing Amniocentesis American. J Res
Communication 2014;2:97‑108.
28. Balci O, Acar A, Mahmoud AS, Colakoglu MC. Effect of
pre-amniocentesis counseling on maternal pain and anxiety.
J Obstetrics Gynaecol Res 2011;37:1828‑32.
29. Björklund U, Marsk A, Ohman SG. Does an information film about
prenatal testing in early pregnancy affect women’s anxiety and
worries? J Psychosom Obstet Gynaecol 2013;34:9‑14.
30. Kaiser AS, Ferris LE, Katz R, Pastuszak A, Llewellyn‑Thomas H,
Johnson JA, et al. Psychological responses to prenatal NTS
counseling and the uptake of invasive testing in women of
advanced maternal age. Patient Educ Couns 2004;54:45‑53.
31. Hoseini ES, RahmatiR, Shaghaghi F, BeigiM, Mohebbi‑DehnaviZ.
The relationship between hope and happiness with prenatal care.
J Edu Health Promot 2020;9:206.
32. Noroozi M, Gholami M, Mohebbi‑Dehnavi Z. The relationship
between hope and resilience with promoting maternal attachment
to the fetus during pregnancy. J Educ Health Promot 2020;9:54.
33. Asadi L, Beigi M, Valiani M, Mardani F. Evidence‑based draft
guideline for prevention of midwifery malpractices based on
referred cases to the forensic medicine commission and the
medical council from 2006‑2011. Iran J Nurs Midwifery Res
2017;22:313‑8.
34. Isfahani S, Alipour A, Ali Akbari Dehkordi M. The Effect of Life
Skills Training on Pregnancy Anxiety, Understanding Stress and
Mental Health of Primiparous Women. Tehran, South of Tehran:
Payame Noor University; 2011.
35. Yazdanpanah E, Atghaei M, Hosseinifard S, Fazilat Pour M,
Jahani YA. A Comparison between the Effects of Counseling
Using Cognitive Behavioral Approach and Attentional Bias
Modification Based on Dot‑Probe Task on Anxiety in Pregnant
Women Refering to Kerman Health‑Care Center in 20l6. Kerman,
Iran: School of Nursing, Kerman University of Medical Sciences;
2017.
)