Background Given the prevalence of infertility and consequences of stress, anxiety, and depression during pregnancy and after childbirth, this study aimed to determine the effect of group cognitive behavioral therapy (CBT)-based counseling on perceived stress (primary outcome), anxiety, depression, and quality of life (QoL) of pregnant women with a history of primary infertility. Method This controlled randomized clinical trial was conducted on 56 pregnant women with a history of primary infertility referred to Infertility Clinic of Al-Zahra Teaching Hospital of Tabriz. The participants were divided into the intervention (n = 28) and control (n = 28) groups using block randomization. The intervention group received group CBT-based counseling after the 14th week of the pregnancy: six in-person sessions and two telephone sessions once per week. The control group received routine care. The Perceived Stress Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), Van den Bergh’s Pregnancy-Related Anxiety Questionnaire (PRAQ), and Quality of Life in Pregnancy (Gravidarum) (QOL-GRAV) were completed through interviews before and 4 weeks after the intervention by the researcher. Results There was not any between-group difference in socio-demographic characteristics, except the gestational age and husband educational level (p > 0.05). Both of these variables were adjusted in ANCOVA. After the intervention, the mean scores of perceived stress (mean difference: − 7.3; confidence interval: 95%, from − 0.9 to − 5.6; p < 0.001) and anxiety (mean difference:-14.7; confidence interval: 95%. from − 20.6 to - 8.8; p < 0.001) were significantly lower in the intervention group. The mean depression score in the intervention group was lower than the control; however, this between-group difference was not significant (mean difference: − 1.95; confidence interval: 95% from − 3.9 to 0.2; p = 0.052). The mean score of quality of life in pregnancy was significantly higher in the intervention group than the control (mean difference: − 5.4; confidence interval: 95% from 3.4 to 7.4; p < 0.001). Conclusion CBT counseling can affect the perceived stress, anxiety, and quality of life of pregnant women with a history of primary infertility. As a result, this counseling approach is recommended along with other counseling approaches to improve the mental health of pregnant women with a history of infertility. Trial registration IRCT Registration Number: IRCT20111219008459N12, registered on 10/11/ 2018.

Context:The prevalence of infertility, as one of the most unpleasant experiences, is approximately 13.2% in Iran. It can affect the quality of life in infertile people through mental disorders, such as depression and anxiety. Objectives: This systematic review was carried out to assess the effect of cognitive-behavioral therapy (CBT) on anxiety and depression of infertile women in Iran. Data Sources: All articles published in English and Persian until 20 February 2019 in databases, including Magiran, Iranmedex, SID, Medline (via PubMed), Scopus, Google Scholar, Embase, Cochrane Library, and Web of Sciences were searched. Study Selection: All randomized controlled clinical trials conducted in Iran on the effect of CBT on anxiety and depression were studied. In the selected studies, participants were Iranian infertile women. The used intervention was the application of CBT, the control group had received only routine care, and the outcomes were anxiety and depression. Data Extraction: Two authors separately investigated the acceptability and quality of articles, and any disagreement was solved through consensus and a third opinion. Results: Six clinical trials with 321 infertile women entered the systematic review. The meta-analysis of six studies showed that the mean depression and anxiety score in the CBT group was lower than the routine care group, which was significant only for anxiety. Conclusions:The results indicated the effectiveness of CBT intervention in reducing anxiety and depression in infertile women. However, the between-group difference was not significant in terms of depression. Convenience sampling and small sample size in the selected studies reduced the generalizability of research findings. Therefore, it is recommended to conduct clinical trials with larger sample size and accurate methodology to obtain more generalizable results.

Objective: To determine the status of self-care performance of pregnant women in the prevention of COVID-19 disease and its relationship with perceived stress during the epidemic period of this disease. Method: This cross-sectional study was performed on 228 pregnant women who referred to the health centers in Tabriz, Iran, for prenatal care. They were selected by cluster sampling. Data collection tools included questionnaires about Demographic-Social Characteristics, the Self-Care Performance Questionnaire and Cohen’s Perceived Stress Scale. Spearman correlation test was used to examine the correlation between self-care performance and perceived stress in bivariate and multivariate analyses. Also, multivariate linear regression was used, with control of demographic-social and obstetric characteristics as possible confounders. Results: The median (25-75 percentiles) self-care performance score of participants was 0.71 (0.65-0.76), from the achievable range of 20-80, and its mean (± SD) perceived stress score was 25.5 (± 5.6), from the achievable range of 0- 56. The Spearman’s rank correlation test results showed a significant inverse correlation between perceived stress and self-care performance scores (r = -0.13; P = 0.041). According to multivariate linear regression test, the variables of selfcare performance, education, spouse's education and number of family members were the predictors of perceived stress in pregnant women during the COVID-19 epidemic. Conclusion: According to the results of the present study, self-care performance of pregnant women in prevention of the COVID-19 disease was good and their stress was moderate. There was a significant inverse correlation between selfcare performance and perceived stress that could indicate the high value and importance of the fetus for the mother and her strict adherence to health protocols to prevent COVID-19, which also leads to calming and reduced perceived stress.

Background: The crisis of COVID-19 disease causes stress in the whole population, including pregnant women, and because pregnancy is a potentially stressful event, it can lead to complications in both mother and fetus. Considering the importance of prevention in controlling of this infection, the present study was conducted to determine the status of self-care performance of pregnant women in the prevention of COVID-19 disease and its relationship with perceived stress during the epidemic period of this disease.Method: This cross-sectional study was performed on 228 pregnant women who referred to Tabriz-Iran health centers for prenatal care by cluster sampling. Data collection tools included questionnaires of demographic-social characteristics, self-care performance and perceived stress. Spearman correlation test was used to examine the correlation between self-care performance and perceived stress in bivariate analysis and in multivariate analysis, multivariate linear regression with control of demographic-social and obstetric characteristics as possible confounders, was used.Results: The median (25-75 percentiles) self-care performance score of participants was 0.71 (0.65-0.76) from the achievable range of 20-80, and the mean (±SD) perceived stress score of them was 25.5 (± 5.6) from the achievable range of 0-56. The Spearman’s rank correlation test results showed a significant inverse correlation between perceived stress and self-care performance scores. According to multivariate linear regression test, the variables of self-care performance, education, spouse's education and number of family members were the predictors of perceived stress in pregnant women during COVID-19 epidemic. Conclusion: According to the results of the present study, the self-care performance of pregnant women in the prevention of COVID-19 disease was good and their stress was moderate. There was a significant inverse correlation between self-care performance and perceived stress, which could indicate the high value and importance of the fetus for the mother and strict adherence to health protocols to prevent COVID-19, which also leads to calming and reduced perceived stress.

BackgroundGiven the prevalence of infertility and consequences of stress, anxiety, and depression during pregnancy and after childbirth, this study aimed to determine the effect of cognitive behavioral therapy (CBT)-based counseling on perceived stress (primary outcome), anxiety, depression, and quality of life (QoL) of pregnant women with a history of primary infertility (secondary outcome).Method:This controlled randomized clinical trial was conducted on 56 pregnant women with a history of primary infertility referred to Infertility Clinic of Al-Zahra Teaching Hospital of Tabriz. The participants were divided into the intervention (n = 28) and control (n = 28) groups using block randomization. The intervention group received group CBT-based counseling after the 14th week of the pregnancy: six in-person sessions and two telephone sessions once per week. The control group received routine care. The Perceived Stress Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), Van den Bergh’s Pregnancy-Related Anxiety Questionnaire (PRAQ), and Quality of Life in Pregnancy (Gravidarum) (QOL-GRAV) were completed through interviews before and four weeks after the intervention by the researcher.ResultsThere was not any between-group difference in socio-demographic characteristics, except the gestational age and husband educational level (p > 0.05). Both of these variables were adjusted in ANCOVA. After the intervention, the mean scores of perceived stress (mean difference: -7.3; confidence interval: 95%, from − 0.9 to -5.6; p < 0.001) and anxiety (mean difference:-14.7; confidence interval: 95%. from − 20.6 to − 8.8; p < 0.001) were significantly lower in the intervention group. The mean depression score in the intervention group was lower than the control; however, this between-group difference was not significant (mean difference: -1.95; confidence interval: 95% from − 3.9 to 0.2; p = 0.052). The mean score of quality of life in pregnancy was significantly higher in the intervention group than the control (mean difference: -5.4; confidence interval: 95% from 3.4 to 7.4; p < 0.001).ConclusionCBT counseling can affect the perceived stress, anxiety, and quality of life of pregnant women with a history of primary infertility. As a result, this counseling approach is recommended along with other counseling approaches to improve the mental health of pregnant women with a history of infertility.Trial RegistrationIRCT Registration Number: IRCT20111219008459N12, registered on 10/11/ 2018 (https://irct.ir/user/trial/34677)