Reducing Anxiety of Pregnant Women with a History of Pregnancy Loss-A Randomize Clinical Trial

Author(s): Hoda Zaraj, Katayon Vakilian*, Fatemeh Mehrabi Rezveh

Journal Name: Current Women`s Health Reviews

Volume 16 , Issue 2 , 2020

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Graphical Abstract:


Background: Spontaneous abortion is the most common complication of pregnancy which is considered an unfavorable experience both physically and psychologically.

Objective: This study was conducted to investigate the effect of group counseling through cognitive behavioral therapy (CBT) on the anxiety of pregnant women with a history of spontaneous abortion.

Methods: This study was randomized clinical trial type, in which convenient sampling was performed to select 64 subjects from healthcare centers in Arak province. After receiving written consent from the participants, the sampling was performed and the subjects were categorized randomly into two 32-subject groups as intervention and control. The intervention was performed as six 60- min sessions through cognitive behavioral therapy (CBT). Control group, however, only routine cares of pregnancy were provided. For data collection, The Spielberger State-Trait Anxiety Inventory was utilized at the beginning and end of the study. Then, the collected information was analyzed by SPSS 21 through paired t-test, independent t-test.

Results: The mean anxiety after the intervention in the intervention and control groups was 65.13±8.11 and 75.91±5.56, respectively, whereby a significant difference was observed between the two groups (p≤0.05).

Conclusion: It seems that women with a previous history of abortion require psychological support during pregnancy. It is recommended that the skills of midwives also be improved to psychologically support these women.

Keywords: Group counseling, cognitive behavioral therapy, pregnancy, abortion, prenatal care, pregnancy loss.

Wijesooriya L, Palihawadana T, Rajapaksha R. A study of psychological impact on women undergoing miscarriage at a Sri Lankan hospital setting. SLJOG 2015; 37(2): 10-3.
Bernabé-Ortiz A, White PJ, Carcamo CP, et al. Clandestine induced abortion: prevalence, incidence and risk factors among women in a Latin American country. CMAJ 2009; 180(3): 298-304.
[] [PMID: 19188628]
Sedgh G, Bearak J, Singh S, et al. Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. Lancet 2016; 388(10041): 258-67.
[] [PMID: 27179755]
Scott JR, Gibbs RS, Karlan BY, et al. Danforth's obstetrics and gynecology, . 9th (ed.). Lippincot Willims & Wikins; . 2003.
Steinberg JR, Russo NF. Abortion and anxiety: what’s the relationship? Soc Sci Med 2008; 67(2): 238-52.
[] [PMID: 18468755]
Littleton HL, Breitkopf CR, Berenson AB. Correlates of anxiety symptoms during pregnancy and association with perinatal outcomes: a meta-analysis. Am J Obstet Gynecol 2007; 196(5): 424-32.
[] [PMID: 17466693]
Neugebauer R, Kline J, Stein Z, Shrout P, Warburton D, Susser M. Association of stressful life events with chromosomally normal spontaneous abortion. Am J Epidemiol 1996; 143(6): 588-96.
[] [PMID: 8610676]
Van den Bergh BR, Mulder EJ, Mennes M, Glover V. Antenatal maternal anxiety and stress and the neurobehavioural development of the fetus and child: links and possible mechanisms. A review. Neurosci Biobehav Rev 2005; 29(2): 237-58.
[] [PMID: 15811496]
Waldie KE, Peterson ER, D’Souza S, et al. Depression symptoms during pregnancy: Evidence from Growing Up in New Zealand. J Affect Disord 2015; 186: 66-73.
[] [PMID: 26231443]
Vakilian K, Zarei F, Majidi A. Effect of Acceptance and Commitment Therapy (ACT) on anxiety and quality of life during pregnancy: A mental health clinical trial study. IRCMJ 2019; 21(8): e89489
Andersson L, Sundström-Poromaa I, Wulff M, Aström M, Bixo M. Depression and anxiety during pregnancy and six months postpartum: a follow-up study. Acta Obstet Gynecol Scand 2006; 85(8): 937-44.
[] [PMID: 16862471]
van Bussel JC, Spitz B, Demyttenaere K. Anxiety in pregnant and postpartum women. An exploratory study of the role of maternal orientations. J Affect Disord 2009; 114(1-3): 232-42.
[] [PMID: 18793805]
Gómez Lavín C, Zapata García R. Diagnostic categorization of post-abortion syndrome. Actas Esp Psiquiatr 2005; 33(4): 267-72.
[PMID: 15999304]
Hutti MH. Social and professional support needs of families after perinatal loss. Obstet Gyneco neonatal Nurs 2005; 34: 630-8.
Nansel TR, Doyle F, Frederick MM, Zhang J. Quality of life in women undergoing medical treatment for early pregnancy failure. J Obstet Gynecol Neonatal Nurs 2005; 34(4): 473-81.
[] [PMID: 16020415]
Haghparast E, Faramarzi M, Hassanzadeh R. Psychiatric symptoms and pregnancy distress in subsequent pregnancy after spontaneous abortion history. Pak J Med Sci 2016; 32(5): 1097-101.
[] [PMID: 27882001]
Rahbar N, Ghorbani R, Moazen S, Asl NS. Association between spontaneous abortion and general health condition. Articlein Persian. IJOGI 2010; 13(1): 7-12.
Kush FR, Fleming LM. An innovative approach to short-term group cognitive therapy in the combined treatment of anxiety and depression. Group Dyn Theor Res 2000; 4(2): 176-83.
Ryding EL, Wirfelt E, Wängborg IB, Sjögren B, Edman G. Personality and fear of childbirth. Acta Obstet Gynecol Scand 2007; 86(7): 814-20.
[] [PMID: 17611826]
Rygh JL, Sanderson WC. Treating generalized anxiety disorder: evidenced-based strategies, tools, and techniques. New York: Guilford Press 2004.
Sukhodolsky DG, Kassinove H, Gorman BS. Cognitive-behavioral therapy for anger in children and adolescents: A meta-analysis. Aggress Violent Behav 2004; 9(3): 247-69.
Breslau N, Schultz L, Peterson E. Sex differences in depression: a role for preexisting anxiety. Psychiatry Res 1995; 58(1): 1-12.
[] [PMID: 8539307]
Huang Z, Hao J, Su P, Huang K, Xing X, Cheng D. The impact of prior abortion on anxiety and depression symptoms during a subsequent pregnancy: Data from a population-based cohort study in China. Klinik Psikofarmakol Bülteni 2012; 22(1): 51-8.
Rahimi F, Ahmadi M, Rosta F, Majd HA, Valiani M. Effect of relaxation training on pregnancy anxiety in high risk women. Safety Promot Inj Prev 2014; 2(3): 180-9.
Nasiri Amiri F, Salmalian H, Haji Ahmadi M, Ahmadi AM. Relationship between maternal anxiety in the incidence of spontaneous preterm birth. J Babol Univ Med Sci 2009; 11(4): 42-8.
Séjourné N, Callahan S, Chabrol H. The utility of a psychological intervention for coping with spontaneous abortion. J Reprod Infant Psychol 2010; 28(3): 287-96.
Nakano Y, Akechi T, Furukawa TA, Sugiura-Ogasawara M. Cognitive behavior therapy for psychological distress in patients with recurrent miscarriage. Psychol Res Behav Manag 2013; 6: 37-43.
[] [PMID: 23901302]
Urech C, Fink NS, Hoesli I, Wilhelm FH, Bitzer J, Alder J. Effects of relaxation on psychobiological wellbeing during pregnancy: a randomized controlled trial. Psychoneuroendocrinology 2010; 35(9): 1348-55.
[] [PMID: 20417038]
Ventura T, Gomes MC, Carreira T. Cortisol and anxiety response to a relaxing intervention on pregnant women awaiting amniocentesis. Psychoneuroendocrinology 2012; 37(1): 148-56.
[] [PMID: 21705148]
Bastani F, Hidarnia A, Kazemnejad A, Vafaei M, Kashanian M. A randomized controlled trial of the effects of applied relaxation training on reducing anxiety and perceived stress in pregnant women. J Midwifery Womens Health 2005; 50(4): e36-40.
[] [PMID: 15973255]
Bastani F, Hidarnia A, Montgomery KS, Aguilar-Vafaei ME, Kazemnejad A. Does relaxation education in anxious primigravid Iranian women influence adverse pregnancy outcomes?: a randomized controlled trial. J Perinat Neonatal Nurs 2006; 20(2): 138-46.
[] [PMID: 16714913]
Goodman JH, Guarino A, Chenausky K, et al. CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Arch Women Ment Health 2014; 17(5): 373-87.
[] [PMID: 24449191]
Arch JJ. Cognitive behavioral therapy and pharmacotherapy for anxiety: treatment preferences and credibility among pregnant and non-pregnant women. Behav Res Ther 2014; 52: 53-60.
[] [PMID: 24326075]
Karami KH, Mardani A, Shakerinejad GH, Saki A. Effectiveness of a codified educational behavioral program on the mental health of pregnant women. J Shahid Sadoughi Univ Med Sci 2015; 23(9): 879-89.
Witt WP, DeLeire T, Hagen EW, et al. The prevalence and determinants of antepartum mental health problems among women in the USA: a nationally representative population-based study. Arch Women Ment Health 2010; 13(5): 425-37.
[] [PMID: 20668895]
Faramarzi M, Alipor A, Esmaelzadeh S, Kheirkhah F, Poladi K, Pash H. Treatment of depression and anxiety in infertile women: cognitive behavioral therapy versus fluoxetine. J Affect Disord 2008; 108(1-2): 159-64.
[] [PMID: 17936366]
Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognit Ther Res 2012; 36(5): 427-40.
[] [PMID: 23459093]

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Article Details

Year: 2020
Published on: 28 April, 2020
Page: [160 - 166]
Pages: 7
DOI: 10.2174/1573404816666200206105120

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