Document Type : Original Article

Authors

1 Department of Public Health, Social Determinants of Health Research Center, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran, Department of Midwifery, Shahid Rahimi (Tamin Ejtemaei) Hospital, Birjand, Iran

2 Department of Epidemiology and Biostatistics, Social Determinants of Health Research Center, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran

3 Department of Midwifery, Faculty of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran

4 Department of Public Health, Social Determinants of Health Research Center, Faculty of Health, Birjand University of Medical Sciences, Birjand, Iran

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.

Keywords

1. Littleton HL, Breitkopf CR, Berenson AB. Correlates of anxiety
symptoms during pregnancy and association with perinatal
outcomes: A meta‑analysis. Am J Obstet Gynecol 2007;196:424‑32.
2. Waldenström U, Hildingsson I, Ryding EL. Antenatal fear of
childbirth and its association with subsequent caesarean section
and experience of childbirth. BJOG 2006;113:638‑46.
3. Madhavanprabhakaran GK, D’Souza MS, Nairy KS. Prevalence
of pregnancy anxiety and associated factors. Int J Afr Nurs Sci
2015;3:1‑7.
4. ShahnaziH, SabootehS, SharifiradG, MirkarimiK, HassanzadehA.
The impact of education intervention on the Health Belief Model
constructs regarding anxiety of nulliparous pregnant women.J
Educ Health Promot2015;4:27.
5. Nekoee T, Zarei M. Evaluation the anxiety status of pregnant
women in the third trimester of pregnancy and fear of childbirth
and related factors. Br J Med Med Res 2015;9:1‑8.
6. Rezaee R, Framarzi M. Predictors of mental health during
pregnancy.Iran J Nurs Midwifery Res2014;19:S45‑50.
7. Shishehgar S, Dolatian M, Majd HA, Bakhtiary M. Perceived pregnancy stress and quality of life amongst Iranian women.Glob
J Health Sci2014;6:270‑7.
8. Ding XX, Wu YL, Xu SJ, Zhu RP, Jia XM, Zhang SF, et al.
Maternal anxiety during pregnancy and adverse birth outcomes:
A systematic review and meta‑analysis of prospective cohort
studies.J Affect Disord2014;159:103‑10.
9. Staneva A, Bogossian F, Pritchard M, Wittkowski A. The effects
of maternal depression, anxiety, and perceived stress during
pregnancy on preterm birth: A systematic review.Women
Birth2015;28:179‑93.
10. Liou SR, WangP, Cheng CY. Effects of prenatal maternal mental
distress on birth outcomes.Women Birth2016;29:376‑80.
11. DunkelSchetter C, Tanner L. Anxiety, depression and stress in
pregnancy: Implications for mothers, children, research, and
practice.Curr Opin Psychiatry2012;25:141‑8.
12. Andersson L, Sundström‑PoromaaI, Wulff M, Aström M,
Bixo M. Neonatal outcome following maternal antenatal
depression and anxiety: A population‑based study. Am J
Epidemiol2004;159:872‑81.
13. Drummond J, Rickwood D. Childbirth confidence: Validating
the childbirth self-efficacy inventory (CBSEI) in an Australian
sample. J Adv Nurs 1997;26:613‑22.
14. Berentson‐Shaw J, Scott KM, Jose PE. Do self-efficacy beliefs
predict the primiparous labour and birth experience? A
longitudinal study. J Reprod Infant Psychol 2009;27:357‑73.
15. Salomonsson B, Gullberg MT, Alehagen S, Wijma K. Self‑efficacy
beliefs and fear of childbirth in nulliparous women.J Psychosom
Obstet Gynaecol2013;34:116‑21.
16. Toohill J, Fenwick J, Gamble J, Creedy DK, Buist A, Turkstra E,
et al. A randomized controlled trial of a psycho-education
intervention by midwives in reducing childbirth fear in pregnant
women. Birth 2014;41:384‑94.
17. Byrne J, Hauck Y, Fisher C, Bayes S, Schutze R. Effectiveness of a
mindfulness-based childbirth education pilot study on maternal
self-efficacy and fear of childbirth. J Midwifery Womens Health
2014;59:192‑7.
18. Ip WY, Tang CS, Goggins WB. An educational intervention
to improve women’s ability to cope with childbirth.J Clin
Nurs2009;18:2125‑35.
19. Tragea C, Chrousos GP, AlexopoulosEC, Darviri C. Arandomized
controlled trial of the effects of a stress management programme
during pregnancy.Complement Ther Med2014;22:203‑11.
20. Malekpour – Afshar F, Salari P, Azar Pedjouh H, Ismaeili H.
Evaluation of the Effect of the Education Module “Preparing
For Childbirth” on the Level of Anxiety during Pregnancy and
Labor in Primigravida Women. The Journal of Shahid Sadoughi
University of Medical Sciences. 2005;13(3):39‑44.
21. Sinesi A, Maxwell M, O’Carroll R, Cheyne H. Anxiety scales used
in pregnancy: Systematic review.BJPsych Open2019;5:e5.
22. Babanazari L, Kafi M. Relationship of pregnancy anxiety to its
different periods, sexual satisfaction and demographic factors.
Iran J Psychiatry Clin Psychol 2008;14:206‑13.
23. Bandura A. Self-efficacy. In: The Corsini Encyclopedia of
Psychology. John Wiley and Sons, Inc.New Jersey, United States;
2010. p. 1‑3.
24. Maddux JE. Self‑efficacy theory. In: Self‑Efficacy, Adaptation,
and Adjustment. Springer; New York City, United States 1995.
p. 3‑33.
25. Bandura A, Locke EA. Negative self‑efficacy and goal effects
revisited.J Appl Psychol 2003;88:87‑99.
26. Glazier RH, Elgar FJ, GoelV, Holzapfel S. Stress, social support,
and emotional distress in a community sample of pregnant
women.J Psychosom Obstet Gynaecol2004;25:247‑55.
27. NasiriS, AkbariH, TagharrobiL, TabatabaeeAS. The effect of
progressive muscle relaxation and guided imagery on stress,
anxiety, and depression of pregnant women referred to health
centers.J Educ Health Promot2018;7:41.
28. World Health Organization. Global Nutrition Targets 2025: Low
Birth Weight Policy Brief. Geneva: World Health Organization;
2019. Available from: https://www.who.int/nutrition/
publications/globaltargets2025_policybrief_lbw/en/. [Last
accessed on 2010 Sep 21].
29. World Health Organization. Global Nutrition Targets 2025:
Low Birth Weight Policy Brief. World Health Organization;
Geneva, Switzerland 2014.
30. Ryding EL, Wijma B, WijmaK, RydhströmH. Fear of childbirth
during pregnancy may increase the risk of emergency cesarean
section.Acta Obstet Gynecol Scand1998;77:542‑7.
31. Wax JR, CartinA, Pinette MG, BlackstoneJ. Patient choice cesarean:
An evidence‑based review.Obstet Gynecol Surv2004;59:601‑16.
32. LeiH, Wen SW, Walker M. Determinants of caesarean delivery
among women hospitalized for childbirth in a remote population
in China.J Obstet Gynaecol Can2003;25:937‑43.