This descriptive cross-sectional study was conducted on 484 pregnant women participated in the study between May 5 and Aug 5, 2020. Table 1 shows the characteristics of the participating samples. The mean age, gestational age and years of education were 28.3 ± 5.8 year (range: 16–47), 24.3 ± 8.9 weeks (range: 4–40), and 13.6 ± 3.6 year (range: 2–25), respectively. All women were married. Of the 484 women, 234 (48.3%) were nulliparous, 22.9% were employed, 41.1% had a university degree, and 85.4% were in a middle or high-income category. Among women who were employed, 54 women had been working at home since the COVID-19 outbreak.
Table 1
Women’s worry by their socio-demographic/obstetric characteristics.
|
|
Worry scores
|
|
Socio-demographic variables
|
N (%)
|
Mean ± SD
|
P
|
Age (year)
|
|
|
0.005**†
|
< 20
|
28 (5.8)
|
39.2 ± 28.3
|
|
20–30
|
286 (59.1)
|
41.1 ± 22.1
|
|
> 30
|
170 (35.1)
|
34.0 ± 22.6
|
|
Job
|
|
|
0.002**†
|
Housewife
|
373 (77.1)
|
36.8 ± 22.3
|
|
Employed
|
111 (22.9)
|
44.2 ± 23.2
|
|
Education
|
|
|
0.069†
|
Primary School
|
26 (5.4)
|
33.8 ± 27.9
|
|
Diploma
|
183 (37.8)
|
36.1 ± 24.2
|
|
University
|
275 (41.1)
|
40.5 ± 21.0
|
|
Family income
|
|
|
< 0.001***†
|
Low income
|
71 (14.7)
|
48.3 ± 26.2
|
|
Middle income
|
401 (82.9)
|
37.0 ± 21.6
|
|
High income
|
12 (2.5)
|
31.4 ± 24.3
|
|
Husband age
|
|
|
0.304
|
< 30
|
135 (27.9)
|
40.2 ± 23.2
|
|
30–40
|
291(60.1)
|
38.4 ± 22.4
|
|
> 40
|
58 (12)
|
34.7 ± 23.1
|
|
Husband education
|
|
|
0.012*†
|
Primary School
|
56 (11.6)
|
31.5 ± 26.0
|
|
Diploma
|
201 (41.5)
|
37.5 ± 23.0
|
|
University
|
227 (31.8)
|
41.1 ± 21.2
|
|
Husband job
|
|
|
0.132†
|
Worker
|
117 (24.2)
|
41.9 ± 24.5
|
|
Clerk
|
128 (26.4)
|
38.6 ± 20.8
|
|
Self-employed
|
239 (49.4)
|
36.7 ± 22.6
|
|
Close family member with chronic disease
|
|
|
0.034*†
|
Yes
|
85 (17.6)
|
33.7 ± 20.3
|
|
No
|
399 (82.4)
|
39.5 ± 23.1
|
|
COVID-19 infected person among relatives
|
|
|
0.026*†
|
Yes
|
38 (7.9)
|
46.3 ± 20.5
|
|
No
|
446 (92.1)
|
37.8 ± 22.8
|
|
Death due to COVID-19 among relatives
|
|
|
0. 322
|
Yes
|
20 (4.1)
|
43.4 ± 21.3
|
|
No
|
464 (95.9)
|
38.3 ± 22.8
|
|
Fear of COVID-19
|
|
|
< 0.001***†
|
Not at all to moderate
|
272 (70.8)
|
29.0 ± 21.2
|
|
High to Severe
|
212 (29.2)
|
50.6 ± 18.2
|
|
Period
|
|
|
0.001**
|
After the first wave of COVID-19
|
384 (79.3)
|
40.6 ± 20.8
|
|
During the second wave of COVID-19
|
100 (20.7)
|
30.2 ± 27.3
|
|
Obstetrics variables
|
|
|
|
Gestational age (week)
|
|
|
< 0.001***†
|
First trimester
|
75 (15.5)
|
28.5 ± 23.0
|
|
Second trimester
|
187 (38.6)
|
.9 ± 20.240
|
|
Third trimester
|
222 (45.9)
|
39.8 ± 23.8
|
|
Parity
|
|
|
0.003**†
|
Nullipara
|
234 (48.3)
|
41.6 ± 22.3
|
|
Primipara/Multipara
|
250 (52.7)
|
35.5 ± 22.7
|
|
Abortion history
|
|
|
0.228†
|
Yes
|
131 (27.1)
|
40.5 ± 22.8
|
|
No
|
353 (72.9)
|
37.7 ± 22.7
|
|
Pregnancy complication
|
|
|
0.333
|
Yes
|
44 (9.1)
|
41.6 ± 20.1
|
|
No
|
440 (90.9)
|
38.2 ± 22.9
|
|
Poor obstetric history
|
|
|
0.079†
|
Yes
|
54 (11.2)
|
43.0 ± 19.3
|
|
No
|
430 (88.8)
|
37.9 ± 23.1
|
|
*p < 0.05, **p < 0.01, ***p < 0.001, †selected for multiple regression analysis
|
Thirty-eight women reported that they had an infected person among their relatives and 20 reported at least one death due to COVID-19 in their extended families. These two groups had a higher level of fear of COVID-19 than their counterparts (p = 0.01 and p = 0.002, respectively). There was no significant difference in fear of COVID-19 between nulliparas and primi/multiparas (p = 0.313). Women in their second and third trimester of pregnancy had a higher level of fear of COVID-19 than those in their first trimester. The mean scores of the WHO-5 well-being index and the CWS were (64.9 ± 29.0) and (38.5 ± 22.7), respectively. Of the 484 women, 111 (24.4%) had a low level of well-being requiring further evaluation.
Table 1 shows women’s worry by their socio-demographic/obstetric characteristics. Women with one of the following attributes had a higher level of worry in comparison with their counterparts: age < 30 years, nulliparous, employed, those with a low family income, those with higher education levels, those who were in the second and third trimester of pregnancy, those with a high level of fear of COVID-19, and those who had at least one COVID-19 infected person in their relatives. Women who had a close family member with chronic disease had a lower level of worry than their counterparts (p = 0.034). Further investigation revealed that the mean score of socio-medical worries was lower in women who had a close family member with chronic disease than their counterparts (p = 0.008). Women who participated in the study during the first wave of the COVID-19 had a higher level of worry than those who registered during the second wave of the disease in Iran (p < 0.001) (Table 1).
The results of multiple logistic regression analysis on worry scores indicates that the predictors of a low level of women’s worry are the increased level of fear of COVID-19, a low family income, employment status, nulliparity, and having no close family member with chronic disease (Table 2).
Table 2
Predictors of worry among studied variables (results of multiple regression analysis on worry scores).
|
Unstandardized Coefficients
|
Standardized Coefficients
|
|
|
95.0% CI for B
|
Model
|
B
|
S.E
|
Beta
|
t
|
P
|
Lower Bound
|
Upper Bound
|
Fear of COVID-19 (low fear vs. high fear )
|
21.293
|
1.760
|
.466
|
12.096
|
< 0.001
|
17.834
|
24.752
|
Income (low income vs. middle/high income)
|
-11.456
|
2.471
|
− .179
|
-4.636
|
< 0.001
|
-16.311
|
-6.600
|
Job (housewife vs. employed)
|
8.001
|
2.087
|
.148
|
3.834
|
< 0.001
|
3.901
|
12.102
|
Parity (nulliparity vs. primi/multiparity)
|
-5.152
|
1.762
|
− .114
|
-2.924
|
0.004
|
-8.614
|
-1.690
|
Close family member with chronic disease (yes vs. no)
|
4.702
|
2.294
|
.079
|
2.050
|
0.041
|
.195
|
9.209
|
R2 = 29.5%,
|
Table 3 shows women’s well-being by their socio-demographic/obstetric characteristics. Women with one of the following attributes had a lower level of well-being in comparison with their counterparts: women with at least one COVID-infected person among relatives, those with at least one death among their relatives due to COVID-19, and women with a high level of fear of COVID-19.
Table 3
Women’s well-being by their socio-demographic characteristics.
|
|
Well-being
|
|
|
|
WHO-5 index < 50
|
WHO-5 index ≥ 50
|
|
Socio-demographic variables
|
N (%)
|
118 (24.4)
|
366 (75.6)
|
P
|
Age (year)
|
|
|
|
0.847ac
|
< 20
|
28 (5.8)
|
8 (28.6)
|
20 (71.4)
|
|
20–30
|
286 (59.1)
|
68 (23.8)
|
218 (76.2)
|
|
> 30
|
170 (35.1)
|
42 (24.7)
|
128 (75.3)
|
|
Job
|
|
|
|
0.441ac
|
Housewife
|
373 (77.1)
|
94 (25.2)
|
279 (74.8)
|
|
Employed
|
111 (22.9)
|
24 (21.6)
|
87 (78.4)
|
|
Education
|
|
|
|
0.060ac
|
Primary School
|
26 (5.4)
|
4 (15.4)
|
22 (84.6)
|
|
Diploma
|
183 (37.8)
|
55 (30.1)
|
128 (69.9)
|
|
University
|
275 (41.1)
|
59 (21.5)
|
216 (78.5)
|
|
Family income
|
|
|
|
0.232ac
|
Low
|
71 (14.7)
|
23 (32.4)
|
48 (77.6)
|
|
middle
|
401 (82.9)
|
92 (22.9)
|
309 (77.1)
|
|
High
|
12 (2.5)
|
3 (257)
|
9 (75)
|
|
Husband age
|
|
|
|
0.313ac
|
< 30
|
135 (27.9)
|
28 (20.7)
|
107 (79.3)
|
|
30–40
|
291(60.1)
|
78 (26.8)
|
213 (73.2)
|
|
> 40
|
58 (12)
|
12 (20.7)
|
46 (79.3)
|
|
Husband education
|
|
|
|
0.217ac
|
Primary School
|
56 (11.6)
|
13 (23.2)
|
43 (76.8)
|
|
Diploma
|
201 (41.5)
|
57 (28.4)
|
144 (71.6)
|
|
University
|
227 (31.8)
|
48 (21.1)
|
179 (78.9)
|
|
Husband job
|
|
|
|
0.167ac
|
Worker
|
117 (24.2)
|
35 (29.9)
|
82 (70.1)
|
|
Clerk
|
128 (26.4)
|
25 (19.5)
|
103 (80.5)
|
|
Self-employed
|
239 (49.4)
|
58 (24.3)
|
181 (75.7)
|
|
Relative with chronic disease
|
|
|
|
0.300ac
|
Yes
|
85 (17.6)
|
17 (20.0)
|
68 (80.0)
|
|
No
|
399 (82.4)
|
101 (25.3)
|
298 (74.7)
|
|
COVID-19 infected person among relatives
|
|
|
|
0.008ab
|
Yes
|
38 (7.9)
|
16 (42.1)
|
22 (57.9)
|
|
No
|
446 (92.1)
|
102 (22.9)
|
344 (77.1)
|
|
Death due to COVID-19 among relatives
|
|
|
|
0.032†b
|
Yes
|
20 (4.1)
|
9 (45.0)
|
11 (55.0)
|
|
No
|
464 (95.9)
|
109 (23.5)
|
355 (76.5)
|
|
Fear of COVID-19
|
|
|
|
0.016ab
|
Not at all to moderate
|
272 (70.8)
|
55 (20.2)
|
217 (79.8)
|
|
High to Severe
|
212 (29.2)
|
63 (29.7)
|
149 (70.3)
|
|
Period
|
|
|
|
0.377
|
After the first wave of COVID-19
|
384 (79.3)
|
97 (25.3)
|
287 (74.7)
|
|
During the second wave of COVID-19
|
100 (20.7)
|
21 (21.0)
|
79 (79.0)
|
|
Obstetrics variables
|
|
|
|
|
Gestational age (week)
|
|
|
|
0.513ac
|
First trimester
|
75 (15.5)
|
21 (28.0)
|
54 (72.0)
|
|
Second trimester
|
187 (38.6)
|
48 (25.7)
|
139 (74.3)
|
|
Third trimester
|
222 (45.9)
|
49 (22.1)
|
173 (77.9)
|
|
Parity
|
|
|
|
0.992ac
|
Nullipara
|
234 (48.3)
|
57 (24.4)
|
177 (75.6)
|
|
Primipara/Multipara
|
250 (52.7)
|
61 (24.4)
|
189 (75.6)
|
|
Abortion history
|
|
|
|
0.823ac
|
Yes
|
131 (27.1)
|
31 (23.7)
|
100 (76.3)
|
|
No
|
353 (72.9)
|
87 (24.6)
|
266 (75.4)
|
|
Pregnancy complication
|
|
|
|
0.920ac
|
Yes
|
44 (9.1)
|
11 (25)
|
33 (75)
|
|
No
|
440 (90.9)
|
107 (24.3)
|
333 (75.7)
|
|
Poor obstetric history
|
|
|
|
0.341ac
|
Yes
|
54 (11.2)
|
16 (29.6)
|
38 (70.4)
|
|
No
|
430 (88.8)
|
102 (23.7)
|
328 (76.3)
|
|
aPearson Chi-Square, †Fisher exact test. |
bLogistic regression: p < 0.05. |
cLogistic regression: p > 0.05. |
Table 4 indicates that there are statistically significant differences in the mean scores of the Cambridge worry factors for subgroups of women classified according to their WHO-5 well-being score. The results of the logistic regression analysis on well-being scores showed that there is a significant association between the level of well-being in pregnant women with worry about fetus health (OR = 1.081, p = 0.005), worry about their own health and relationships (OR = 1.055, p = .047), and having at least one infected person with COVID-19 among relatives (OR = 2.095, p = 0.039) (Table 5).
Table 4
Differences in the sub-groups of worry by level of psychological well-being.
|
|
Levels of well-being
|
p
|
Worry factors
|
|
WHO-5 < 50 (n = 118)
|
WHO-5 ≥ 50 (n = 366)
|
|
Socio Medical
|
19.9 ± 12.2
|
7.2 ± 5.8
|
5.5 ± 5.3
|
0.002ab
|
Health of mother & Relationships
|
5.6 ± 4.7
|
7.3 ± 4.8
|
5.1 ± 4.5
|
0.001ab
|
Fetus Health
|
6.5 ± 4.8
|
8.3 ± 4.7
|
5.9 ± 4.6
|
< 0.001ab
|
Socio Economic
|
5.9 ± 5.5
|
23.5 ± 11.7
|
18.7 ± 12.1
|
0.091ac
|
aMan-Whitney U
bLogistic regression: p < 0.05.
cLogistic regression: p = 0.055.
|
Table 5
Results of multiple logistic regression analysis on well-being scores.
|
|
|
|
|
|
95% C.I. For B
|
Variables
|
B
|
S.E.
|
Wald
|
P
|
OR
|
Lower
|
Upper
|
Infected person with COVID-19 among relatives
|
0.740
|
0.359
|
4.246
|
0.039
|
2.095
|
1.037
|
4.235
|
Health of mother & Relationships
|
0.053
|
0.027
|
3.937
|
0.047
|
1.055
|
1.001
|
1.111
|
Fetus Health
|
0.078
|
0.028
|
7.926
|
0.005
|
1.081
|
1.024
|
1.141
|
*p<0.05, **p<0.01, Variables entered the logistic regression analysis as independent variable include infection with COVID−19 in relatives, Death due to COVID−19 in relatives, Fear of COVID, four factors of the worry scale. Method of analysis: Backward LR
Cox & Snell R Square = 0.064, Nagelkerke R Square = 0.096
|
We compared pregnant women’s worries during the COVID-19 pandemic and their worries according to our study conducted in 2016 [13]. The results indicate that the mean scores for the two factors designated as ‘worry about the fetus health’ and ‘socio-economic’ are statistically different between the two studies (p < 0.05). Fetus health mean score in the current study was lower than that of the previous study (p = 0.024). Socio-economic mean score in the current study was higher than that of the previous study (p = 0.025) (Table 6).
Table 6
Comparison of pregnant women’s worries during the COVID-19 pandemic and the previous study conducted on 2016.
|
Before COVID-19 pandemic (12) (N = 396)
|
During COVID-19 pandemic (N = 484)
|
|
|
|
Worry scale factors
|
Mean ± SD
|
Mean ± SD
|
t
|
df
|
P
|
Socio Medical
|
19.92 ± 12.16
|
20.10 ± 9.73
|
0 .241
|
878
|
0.809
|
Health of mother & Relationships
|
5.51 ± 4.98
|
5.61 ± 4.71
|
0.316
|
878
|
0.752
|
Fetus Health
|
7.20 ± 4.69
|
6.47 ± 4.78
|
2.266
|
878
|
0.024*
|
Socio Economic
|
5.18 ± 4.45
|
5.93 ± 5.49
|
2.253
|
878
|
0.025*
|
Overall score of Worry
|
37.98 ± 18.41
|
38.48 ± 22.71
|
0.359
|
878
|
0.719
|
*p<0.05
|
We compared pregnant women’s wellbeing scores during the COVID-19 pandemic according to the present study with those reported in another study which was conducted in 2019 [20]. The result indicates that the percentage of participants with a low level of well-being did not differ by the two periods under study (chi-square = 0.099, p = 0.753) (Table 7). The Cronbach’s alpha values for the WHO-5 well-being index and for the CWS in the present study are 0.911 and 0.912, respectively.
Table 7
Comparison of pregnant women’s well-being during the COVID-19 pandemic and the study conducted on 2019.
|
Before COVID-19 pandemic (19)
(N = 396)
|
During COVID-19 pandemic
(N = 484)
|
Well-being levels
|
N (%)
|
N (%)
|
≥ 50
|
403 (74.8)
|
366 (75.6)
|
< 50
|
136 (25.2)
|
118 (24.4)
|
Total
|
539 (100)
|
484 (100)
|
Chi-square = 0,099, p = 0.753
|