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Pregnancy is a unique event for every woman's life which is accompanied by psychological, social and physiological changes . This period requires physical and psychological adjustments for the women, which can affect pregnancy outcomes depending on their function (Vitorino et al., 2018). Meanwhile, the natural process of pregnancy can be disrupted by internal and external stressors (Pakzad et al., 2018). Stress may lead to adverse neonatal outcomes such as preterm labour, miscarriage and low birth weight

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Purpose: Little is known the link between and health promotion behaviors and spiritual well-being in pregnant women. The study aimed to address the existing gap in the context to explore the direct and indirect effect of spirituality on health promotion behaviors with mediatory roles of pregnancy stress, anxiety, and coping ways.Methods: A cross-sectional study was conducted to sampled 200 pregnant women aged above 18 years with gestational age of at least 12 weeks. All participants completed five questionnaires including; Promoting Lifestyle Profile (HPLP), Spiritual Well-Being scale (SWBS), State-Anxiety Inventory (SAI), Prenatal Coping Inventory (Nu-PCI), and Revised Prenatal Distress Questionnaire (NuPDQ). A PLS-SEM model (Partial Least Square Structural Equation) was applied to determine whether spirituality can affect the health promotion behaviors through anxiety, pregnancy stress and coping ways.Results: HPLP were negatively related to state-anxiety (β =-0.36; P<0.001) and positively to planning-preparation coping (β=0.23; P=0.001). Spirituality directly and negatively affected the state-anxiety (β=-0.41; P<0.001) and NuPDQ (β=-0.36; P<0.001), while a direct and positive significant impact on the coping domains including planning-preparation (β=0.36; P<0.001), avoidance (β=0.46; P<0.001), and spiritual-positive coping (β=0.48; P<0.001). Spirituality had a significant indirect effect on HPLP (β = 0.33; P<0.001), mediated through its association with state-anxiety and planning-preparation coping.Conclusion: Spiritual well-being improves promotion healthy behaviors of pregnant women both directly and indirectly by increases planning-preparation copings and decreases the anxiety.