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Volume 9, Issue 2 (Summer 2022)                   J Prevent Med 2022, 9(2): 168-181 | Back to browse issues page

Research code: 036. 1400IR.IAU.TABRIZ.REC.


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Khazaeian S, Fathnezhad-Kazemi A. Perceived Stress and its Predictors in Pregnant Women With Gestational Hypertension: A Cross-Sectional Study. J Prevent Med 2022; 9 (2) :168-181
URL: http://jpm.hums.ac.ir/article-1-576-en.html
1- Department of Midwifery, Pregnancy Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
2- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz Branch of Medical Sciences, Islamic Azad University, Tabriz, Iran.
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Introduction
Gestational hypertension can cause adverse outcomes of pregnancy in mothers and babies. On the other hand, problems related to mental health, such as increased stress, are common in women with high-risk pregnancies. Mothers with gestational hypertension perceive higher stress than other mothers. Stress caused by high-risk pregnancies doubles adverse perinatal outcomes. According to statistics, a significant percentage of pregnant women show some degree of stress symptoms. Several risk factors can be involved in the occurrence of stress. Biological and individual characteristics, psychological factors including personality and mood, health and coping behaviors, and social and environmental resources are among the factors affecting stress. Social support may have a positive effect on reducing stress and increasing adaptation in women. Women who have family support deal with life’s problems in a more logical way. Since the perinatal period is a critical stage during which the protection of mental health should be considered and given that the identification of effective predictors is one of the most important ways for developing prevention models, the present study aims to assess perceived stress and its predictors in pregnant women with gestational hypertension.
Methods
This is a cross-sectional study that was conducted from May to September 2021 on 100 pregnant women with gestational hypertension referred to perinatology clinics of Al-Zahra, Taleghani and 29 Bahman hospitals in Tabriz, Iran who were selected using a convenience sampling method. Inclusion criteria were the ability to read and write, age 40-18 years, singleton pregnancy, a minimum gestational age of 28 weeks, having gestational hypertension and mild preeclampsia without dangerous symptoms, and not experiencing severe stressful events such the death of loved ones in the past six months. The exclusion criteria were unwillingness to participate in the study, return of incomplete questionnaires, and the need to be hospitalized due to having dangerous symptoms. The data were completed using form surveying demographic-obstetric characteristics, the Perceived Stress Scale, and Multidimensional Scale of Perceived Social Support as the self-report tools.
Statistical analysis was done in SPSS v. 22 software. Descriptive statistics (frequency, mean, standard deviation) were used to describe the data. Mann-Whitney U and Kruskal-Wallis tests were used to examine the relationship between variables. Then, the independent variables with P≤0.05 were entered into the regression model to find predictive factors by bivariate and multivariate linear regression analysis (Enter method). The normality of data distribution was checked by the Kolmogorov-Smirnov test.
Results
The mean of age and mean number of pregnancies in the participants were 28.4±67.38 years and 2.30±0.822, respectively. The mean scores of perceived social support and perceived stress were 51.10±20.63 and 41.85±10.30, respectively. It was found that 89% of pregnant women had a stress score above 30. The total score of perceived social support was significantly different between two groups with low and high stress levels (P<0.001). Among the three components of perceived social support, family support and support from significant others were statistically different between the two groups with low and high stress (P<0.05). Mother’s educational level, baby’s gender, previous pregnancy problems, number of pregnancies, and social support were predictors of perceived stress. Based on the adjusted coefficient of determination in the regression model (Adj. R2=0.448), 44.8% of the total changes in perceived stress of pregnant women with gestational hypertension were related to these five independent variables. Among the variables, experiencing problems in the previous pregnancy (β=0.300) and perceived social support (β=-0.273) had the highest impact on perceived stress. 
Discussion
Based on the findings of the present study, the majority of pregnant women with gestational hypertension had high perceived stress. Social support, educational level, number of pregnancies, baby’s gender, and experience of previous pregnancy problems were related to their perceived stress and they can predict it. A negative significant relationship was observed between perceived stress and perceived social support in women. The findings indicate the necessity of paying attention to appropriate sources of social support through the participation of family, society and medical staff during pregnancy. In addition, by increasing the awareness level of mothers in the field of pregnancy problems, stress management training, and providing suitable solutions to prevent or reduce the possible risks along with timely care and the use of adaptive coping strategies, the amount of tension and stress can be reduced in mothers with high-risk pregnancies, especially pregnant women with high blood pressure. In this regard, the attention of health workers to the psychological aspects of women during pregnancy, especially their stress, and providing appropriate support are needed. It is recommended to conduct similar studies on other women with high-risk pregnancy, respecting the limitations of the present study.

Ethical Considerations
Compliance with ethical guidelines

This study has been approved by the Ethics Committee of the Islamic Azad University, Tabriz Branch of Medical Sciences (code number: IR.TBZMED.REC.1400.036). 

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Data collection and review of the article: Somia Khazaian; Designing the study and preparing the original version of the article: Azita Fatehnezhad-Kazemi.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
We thank the women who participated in the study. We also appreciate the support from the Islamic Azad University, Tabriz Branch of Medical Sciences.

 
References
  1. Berhe AK, Kassa GM, Fekadu GA, Muche AA. Prevalence of hypertensive disorders of pregnancy in Ethiopia: A systemic review and meta-analysis. BMC Pregnancy Childbirth. 2018; 18(1):34. [DOI:10.1186/s12884-018-1667-7] [PMID] [PMCID]
  2. Magee LA, von Dadelszen P. State-of-the-art diagnosis and treatment of hypertension in pregnancy. Mayo Clinic Proc. 2018; 93(11):1664-77. [DOI:10.1016/j.mayocp.2018.04.033] [PMID]
  3. Dachew BA, Mamun A, Maravilla JC, Alati R. Association between hypertensive disorders of pregnancy and the development of offspring mental and behavioural problems: A systematic review and meta-analysis. Psychiatry Res. 2018; 1(260):458-67. [DOI:10.1016/j.psychres.2017.12.027] [PMID]
  4. Shay M, MacKinnon AL, Metcalfe A, Giesbrecht G, Campbell T, Nerenberg K, et al. Depressed mood and anxiety as risk factors for hypertensive disorders of pregnancy: A systematic review and meta-analysis. Psychol Med. 2020; 50(13):2128-40. [DOI:10.1017/S0033291720003062] [PMID]
  5. Rouleau CR, Tomfohr-Madsen LM, Campbell TS, Letourneau N, O’Beirne M, Giesbrecht GF, et al. The role of maternal cardiac vagal control in the association between depressive symptoms and gestational hypertension. Biol Psychol. 2016; 117:32-42. [DOI:10.1016/j.biopsycho.2016.02.002] [PMID]
  6. Abedi M, Saboory E, Rabieipour S, Rasoli J. [The relationship between stress in pregnancy, and pregnancy outcomes: A longitudinal study (Persian)]. Nurs Midwifery J. 2017; 14(12):964-81. [Link]
  7. Saur AM, Dos Santos MA. Risk factors associated with stress symptoms during pregnancy and postpartum: Integrative literature review. Women Health. 2021; 61(7):651-67. [DOI:10.1080/03630242.2021.1954132] [PMID]
  8. Glover V. Maternal depression, anxiety and stress during pregnancy and child outcome; What needs to be done. Best Pract Res Clin Obstet Gynaecol. 2014; 28(1):25-35. [DOI:10.1016/j.bpobgyn.2013.08.017] [PMID]
  9. Vameghi R, Amir Aliakbari S, Sajedi F, Sajjadi H, Alavimajd H, Hajighasemali S. [Comparison of stress and perceived social support in mothers of 6-18 month-old children with and without developmental delay (Persian)]. J Hayat. 2015; 21(3):74-87. [Link]
  10. Gausia K, Thompson SC, Nagel T, Schierhout G, Matthews V, Bailie R. Risk of antenatal psychosocial distress in indigenous women and its management at primary health care centres in Australia. Gen Hosp Psychiatry. 2015; 37(4):335-9. [DOI:10.1016/j.genhosppsych.2015.04.005] [PMID]
  11. Kaslow NJ, Bollini AM, Druss B, Glueckauf RL, Goldfrank LR, Kelleher KJ, et al. Health care for the whole person: Research update. Prof Psychol: Res Pract. 2007; 38(3):278-89. [DOI:10.1037/0735-7028.38.3.278]
  12. Moafi F, Dolatian M, Keshavarz Z, Alavi Majd H, Dejman M. [Association between social support and maternal stress with preeclampsia (Persian)]. Refah J. 2013; 13(48):151-70. [Link]
  13. Malakouti J, Sehhati F, Mirghafourvand M, Nahangi R. Relationship between health promoting lifestyle and perceived stress in pregnant women with preeclampsia. J Caring Sci. 2015; 4(2):155-63. [DOI:10.15171/jcs.2015.016] [PMID] [PMCID]
  14. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988; 52(1):30-41.  [DOI:10.1207/s15327752jpa5201_2]
  15. Salami A, Joukar B, Nikpour R. [Internet and communication: Perceived social support and loneliness as antecedent variable (Persian)]. Psychol Stud. 2009; 5(3):81-102. [Link]
  16. Cohen S, Janicki-Deverts DE. Who's stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. J Appl  Soc  Psychol. 2012; 42(6):1320-34. [DOI:10.1111/j.1559-1816.2012.00900.x]
  17. Maroufizadeh S, Zareiyan A, Sigari N. [Psychometric properties of the 14, 10 and 4-item “perceived stress scale” among asthmatic patients in Iran (Persian)]. Payesh (Health Monit). 2014; 13(4):457-65. [Link]
  18. Stark MA, Brinkley RL. The relationship between perceived stress and health-promoting behaviors in high-risk pregnancy. J Perinat Neonatal Nurs. 2007; 21(4):307-14. [DOI:10.1097/01.JPN.0000299788.01420.6e] [PMID]
  19. Gao L, Qu J, Wang AY. Anxiety, depression and social support in pregnant women with a history of recurrent miscarriage: A cross-sectional study. J Reprod Infant Psychol. 2020; 38(5):497-508. [DOI:10.1080/02646838.2019.1652730] [PMID]
  20. Shishehgar S, Dolatian M, Alavi Majd H. A survey of relationship between social support with quality of life as well as stress among pregnant women referred to Shahryar hospital affiliated to social security organization in 1391. Adv Nurs Midwifery. 2014; 23(81):27-32. [Link]
  21. Vianna P, Bauer ME, Dornfeld D, Chies JAB. Distress conditions during pregnancy may lead to pre-eclampsia by increasing cortisol levels and altering lymphocyte sensitivity to glucocorticoids. Med Hypotheses. 2011; 77(2):188-91. [DOI:10.1016/j.mehy.2011.04.007] [PMID]
  22. Heaney JL, Phillips AC, Carroll D. Ageing, depression, anxiety, social support and the diurnal rhythm and awakening response of salivary cortisol. Int J Psychophysiol. 2010; 78(3):201-8. [DOI:10.1016/j.ijpsycho.2010.07.009] [PMID]
  23. Yue C, Liu C, Wang J, Zhang M, Wu H, Li C, et al. Association between social support and anxiety among pregnant women in the third trimester during the coronavirus disease 2019 (covid-19) epidemic in Qingdao, China: The mediating effect of risk perception. Int J Soc Psychiatry. 2021; 67(2):120-7. [DOI:10.1177/0020764020941567] [PMID] [PMCID]
  24. Yesilcinar I, Yavan T, Karasahin KE, Yenen MC. The identification of the relationship between the perceived social support, fatigue levels and maternal attachment during the postpartum period. J Matern Fetal Neonatal Med. 2017; 30(10):1213-20. [DOI:10.1080/14767058.2016.1209649] [PMID]
  25. Babanazari L, Kafi M. [Relationship of pregnancy anxiety to its different periods, sexual satisfaction and demographic factors (Persian)]. Iran J Psychiatry Clin Psychology. 2008; 14(2):206-13. [Link]
  26. Barjasteh S, Moghaddam Tabrizi F. [Antenatal anxiety and pregnancy worries in association with marital and social support (Persian)]. Nurs Midwifery J. 2016; 14(6):504-15. [Link]
  27. Masuodnia E. [Relationship between perceived social support and risk of postpartum depression disorder (Persian)]. Iran J Nurs. 2011; 24(70):8-18. [Link]
  28. Keim SA, Daniels JL, Dole N, Herring AH, Siega-Riz AM, Scheidt PC. A prospective study of maternal anxiety, perceived stress, and depressive symptoms in relation to infant cognitive development. Early Hum Dev. 2011; 87(5):373-80. [DOI:10.1016/j.earlhumdev.2011.02.004] [PMID] [PMCID]
  29. Wu Y, Zhang C, Liu H, Duan C, Li C, Fan J, et al. Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China. American J Obstet  and Gynecol. 2020 Aug 1;223(2):240.e1-e9. [DOI:10.1016/j.ajog.2020.05.009]
  30. Figueiredo B, Conde A. Anxiety and depression symptoms in women and men from early pregnancy to 3-months postpartum: Parity differences and effects. J Affect Disord. 2011; 132(1-2):146-57. [DOI:10.1016/j.jad.2011.02.007] [PMID]
Type of Study: Orginal | Subject: Midwifery
Received: 2021/12/12 | Accepted: 2022/09/1 | Published: 2022/09/1

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