Coronavirus (COVID- 19) has challenged the health care system around the world. One of the main concerns about the disease is the impact of coronavirus on pregnancy and its risk for pregnant women and their children (22). The pregnancy period alone is stressful and full of worries , and recently, the anxiety and worry were added by Coronavirus's epidemic (10). What seems important these days are the formation of relationships and the emergence of behaviors that indicate the critical nature of society, which can affect all aspects of people's lives. It should be noted that no research has been found to examine the relationship between these variables in pregnant women during the epidemic.
In the present study, path analysis showed that during the coronavirus epidemic, the QoL of pregnant women was associated with SF, anxiety, depression, coronavirus disease anxiety, GH, and MS.
Ferreira et al., 2012, concluded that there is a significant relationship between sexual performance and quality of life in pregnant women (23). Also, in the study of Nik Azin et al., 2013, a direct relationship was found between QoL and sexual performance. In this way, people with high sexual function had a higher QoL, both of which correspond to the results of the present study (24).
Sex and marital relationship change due to multiple physical and psychological changes during pregnancy (7), these days, stress and anxiety caused by bad news, fear of infecting oneself and one's family with coronavirus, changes in lifestyle, and normal relationships. Concerns about the future are stressors that can reduce libido and impair sexual function (25). On the other hand, many people tend to have sex because of emotional motivation and insecurity. Numerous studies have shown that more sex equals to less stress (26), and since one of the important physical and psychological dimensions of women's QoL is the quality of people's sexual life, it can be concluded that people with the proper SF will have a better QoL.
Another result of the study was the inverse relationship between QoL and depression and anxiety, which is in line with some study (27, 28), so that with increasing depression, QoL decreases.
Anxiety and depression during pregnancy are serious health problems (29), due to the sudden outbreak of coronavirus, people do not have access to enough information about the disease. Anticipated concerns among pregnant women, such as fear of infection, and vertical transmission from mother to fetus are common. As a result, the coronavirus can be expected to increase the risk of depression in pregnant women (30). Depression also causes adverse consequences of pregnancy and, by influencing the social and environmental psychology of QoL, reduces the QoL (28, 29).
The results of this study also showed that among the variables, GH was more directly related to the QoL, and for the rest of the variables, they acted as intermediaries by relating to the impact GH on QoL. There is a negative and significant relationship between the quality of life and mental health in pregnant women. In fact, due to the negative and inverse correlation, it can be concluded that with increasing quality of life, the mental health of pregnant women decreases. Given that the high scores in the GHQ indicate a more mental disorder, the negative relationship between the two the variable shows that by increasing quality of life scores, the scores of GHQ (mental disorder) decreased and this indicates that mental health is higher in women with a higher quality of life.
The results of Nik Azin et al.'s 2013 study showed that there is a direct relationship between QoL, SF, and GH (24), and Fathi et al., 2013, also stated that there is a negative and significant relationship between GH and QoL in pregnant women (31), which are consistent with the results of the present study.
It should be noted that pregnancy is associated with significant changes in women's mental and physical health, and as social performance in pregnant women is lower than other members of society, can have negative effects on physical health, well-being, and QoL. (31, 32).
Many people, especially those at risk, such as pregnant mothers, are forced to stay at home to prevent the transmission of the coronavirus. Long-term isolation or home-confinement may have negative effects on psychosocial and mental health, especially causing stress, negative emotions, and impairing cognition. If prolonged, they may suppress the immune system and physiological functions. However, about 60% of pregnant women eliminate their physical activity during pregnancy, and it can be said that pregnancy causes women to stop their physical activity at this stage of life or they reduce it. In addition, physical activity is directly related to the quality of life and its dimensions. Hence, with a decrease in physical activity (such as quarantine conditions), the quality of life decreases. So, the study of Slimani et al (2020) showed that physical activity was correlated with all QoL domains during a period of government-directed confinement, and a limitation of personal freedom. It can be concluded that with government restrictions on home-confinement to reduce the incidence, can be expected that the physical activity of pregnant women will decrease compared to before the coronavirus epidemic, and therefore the quality of life of pregnant women will decrease (32-36)
The results of the present study showed that anxiety, directly and indirectly, affects GH, depression, SF, MS, and QoL. This means that pregnant women with a higher level of anxiety had a lower level of quality of life.
Pregnancy is a special time, full of excitement and expectations, but for pregnant mothers, the outbreak of the coronavirus has caused fear, anxiety, and insecurity. Anxiety is a common symptom in patients with chronic respiratory distress that significantly reduces patients' QoL (33). Stress and anxiety can increase the risk of side effects during pregnancy, such as preterm birth, low birth weight, nausea and vomiting, low birth weight, and depression (10, 29).
In the present study, the analysis of the results showed that Coronavirus-inducedanxiety has both direct and indirect effects on QoL. So, pregnant women with higher levels of anxiety had better GH, lower SF, and higher levels of anxiety, depression, and obsession.
The results of Alipour et al., 2020, showed that there was a correlation between Coronavirus-induced anxiety and GH. Thus, increasing the score on the physical and psychological symptoms of Coronavirus-induced anxiety was significantly associated with physical symptoms, depression anxiety, and social dysfunction, which is consistent with the results of the present study (16). Also, the results of studies conducted by Durankuş et al. 2020, and Wu et al 2020, showed that the coronavirus disease epidemic affected the anxiety and depression of pregnant women so that the level of anxiety and depression in pregnant women was higher during the epidemic (29, 30).
Pregnancy is a stressful time for pregnant women. The prevalence of Coronavirus-induced has increased stress and anxiety around the world (29). Anxiety about the coronavirus is common, and it seems to grow more since people are unfamiliar with it and create cognitive ambiguity about the virus. Fear of the unknowns reduces the perception of immunity in humans and has always been a concern for humans (34).
Anxiety has always been endorsed by committed professionals as a health-threatening variable (37). Different types of anxiety disorders can have different effects on SF (38). The findings of a 2013 study by Nick Azin et al. Showed that sexual desire and satisfaction were associated with aspects of QoL and mental health (anxiety, stress, and depression) in pregnant women (24).
Anxiety has a limit, and if it goes too far, it can certainly have devastating effects, including exacerbating obsessive-compulsive behaviors. Obsessive behavior has increased during the coronavirus outbreak. The obsessive-compulsive disorder leads to decreased social, family functioning, and quality of life (39). The results of a 1988 study by Karno et al. showed that people with obsessive-compulsive disorder tend to rate themselves on a lower level of QoL (40).
Facing a crisis prevents a person from working and performing well on the components of problem-solving communication, emotional roles and reactions, emotional involvement (conflict), and behavioral control, Which will lead to a decrease in public health and, consequently, the QoL in the individual (41).