In the present study carried out in the semi-urban region in Northwestern Turkey, one out of every five participating pregnant women in 12th pregnancy week and the following period was determined to suffer from prenatal distress (stress, anxiety, depression). In the literature, the frequency of prenatal distress was 55.6% in Indonesia and 11.9% in women whose gestational age was ≥ 12th weeks in Turkey, and ranged between 37.5% and 54.1% in women whose gestational ages were between 16 and 36 weeks respectively in Iceland [2, 13, 14]. In some studies, the freqency of stress, anxiety, depression during pregnancy ranged between 7.9% and 33.8% [8, 21, 22, 26–28]. In addition, in our study, similar to literature [17, 21, 29–32], the levels of prenatal distress were higher in the participants whose gestational age was between 28th -41st weeks than that in the participants whose gestational age was between 12th -27th weeks. It was reported that prenatal distress experienced during pregnancy was mostly due to changes in women in the second and third trimesters and that mothers in advanced ages can adapt to these changes better [2, 5]. These findings, which were consistent with those in the literature, were associated with the fact that the majority of the participants were in the young age group and had a fear of birth.
It was demonstrated that younger pregnant women were 36% more likely to suffer depression than older pregnant women in Brazil . In a study conducted in the USA, anxiety levels were found to be higher in younger pregnant women . In a study conducted in Indonesia, young age was reported as the most dominant factor affecting prenatal distress in primigravidae.2 According to our results, which were consistent with those in the literature, prenatal distress levels increased both in the pregnant women whose gestational age was between 12th -27th weeks, and in the pregnant women whose gestational age was between 28th -41st weeks as their age decreased [21, 30–32].
In the literature, it was stated that there was an inverse association between the education level and perinatal distress levels, that the low education level poses a risk for distress, and that the high education level was a factor preventing pregnancy distress [19, 20, 22, 28, 29, 32]. In our study, prenatal distress levels were found to be lower as the education level of the pregnant women 12th pregnancy week and the following period or between 12th -27th weeks or between 28th -41st weeks increased. According to this result, which was consistent with the results in the literature, it was thought that people whose education level was high can access more information about pregnancy and birth, and can cope with pregnancy distress more effectively.
In their study, Choi et al. reported that low education level and unemployment led to low income level, which increased pregnancy distress . In several other studies conducted on the issue, it was shown that there was association between financial problems and the levels of prenatal distress including depression, anxiety, and stress [27–29, 32, 33]. On the other hand, in studies conducted with pregnant women in Iceland, Indonesia and South Africa, no association was determined between the income level and prenatal distress levels [2, 8, 14]. In our study, it was associated that the prenatal distress levels of pregnant women who reported had middle and poor income levels after the 12th gestational week or between the 12th -27th weeks of gestation were higher; it was not associated with the 28th -41st weeks. This result could be explained by the fact that the pregnant women focus on the birth process and baby care in the later weeks of pregnancy, or that those with a low perceived income level develop coping strategies.
While prenatal distress levels are high in those with less than two pregnancies 12th pregnancy week and the following period or between 12th -27th gestational weeks; the prenatal distress levels of those who had previous-abortion experience between 12th -27th weeks of gestation and those who had previous-birth experience between 28th -41st weeks of gestation were high. In studies conducted in the USA, the Netherlands, Greece and India, nulliparous women were reported to have significantly higher prenatal distress levels [17, 25, 28, 29]. In a study conducted in Iceland, there was no significant difference between primiparous and multiparous women in terms of their prenatal distress levels ; however, in studies performed in Brazil, France, China, multiparous women were at higher risk of distress [19, 22, 26]. In the literature, it was shown that fetal loss and previous pregnancy loss are the predictors of distress, and that they increase distress levels [7, 8, 20]. These results, which might be due to lack of perceived parental knowledge, low self-efficacy, complications experienced during previous pregnancies and deliveries, fear of birth, inadequate social support levels and unplanned pregnancy were consistent with those in the literature [18, 21, 25, 32].
In our study, it was found that unplanned pregnancies 12th pregnancy week and the following period or 12th -27th weeks or 28th -41st weeks increased prenatal distress levels. A systematic review revealed a strong association between unplanned or unwanted pregnancy, and antenatal depression and anxiety . In a study, antenatal depression in unplanned pregnancies was reported to be significantly more than that in planned pregnancies . Several studies conducted in different countries yielded results similar to those of the present study, and the authors of those studies showed that unplanned pregnancies in women whose gestational age was increased the distress levels [19, 29, 31].
In the literature were shown a negative association between the levels of emotional and practical social support received from the mother, mother-in-law, or spouse/partner or family, and the level of prenatal distress [2, 18, 20, 27, 33]. In our study, prenatal distress levels of the participants increased as their social support levels decreased. In a Canadian study, 12.9% of the pregnant women had inadequate social support, and partner tension affected the anxiety level in the pregnant woman . In parallel with this finding, in our study, while the spouse’s being at a younger age increased prenatal distress levels both in the participants with 12th pregnancy week and the following period or between 12th -27th weeks or between 28th -41st weeks, low education level of the spouse increased the prenatal distress levels in the participants with a gestational age of 28th -41st weeks. Similar to our finding, in a study conducted in Northern Tanzania, the frequency of antenatal depression was reported to be higher in pregnant women whose spouses were young . In a studies conducted Turkey, no association was determined between the distress level and the spouse’s education level . The difference in our results was probably related to the fact that the spouses were knowledgeable and experienced enough in coping with problems likely to arise during pregnancy.