Journal of Preventive Medicine

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.

 
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