Effect of Cognitive Behavioral Therapy-Based Counseling on Perceived Stress in Pregnant Women with History of Primary Infertility: a controlled randomized controlled clinical trial

Abstract

Abstract: Introduction: Given the prevalence of infertility and consequences of stress, anxiety, and depression during pregnancy and after childbirth, interventions that can control the rate of stress in pregnant women with a history of primary infertility will be very helpful. 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). Methods: This controlled randomized clinical trial was conducted on 56 pregnant women with a history of primary infertility visiting the Infertility Clinic of Al-Zahra Teaching Hospital of Tabriz in 2019. Pregnant women aged 20 to 40 years with a history of primary infertility who were pregnant using assisted reproductive methods were divided into the intervention (n=28) and control (n=28) groups using block randomization. For the intervention group, cognitive-behavioral counseling was performed from the 14th week of gestation in 6 sessions of 90-60 minutes, and two telephone sessions weekly by the researcher (in the infertility clinic in a room that was designed for counseling in a quiet setting). The language of consultation was the native language .The control group received routine pregnancy 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 author. Results: In the end of the study 26 participants in the counseling group and 25 in the control group were followed up and analyzed. In the counseling group we had two cases of preterm labor and in the control group three cases of preterm labor. There was not any between-group difference in sociodemographic characteristics, except the gestational age and husband educational attainment. Both of these variables were adjusted in ANCOVA (p>0.05). 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.