This study aimed at investigating the change in HRQL during uncomplicated pregnancies with regard to PC. To this end, the quality of life changes were compared between three groups of pregnancy context; women with planned, unplanned/wanted and unplanned/unwanted pregnancies. The results showed that HRQL had a decreasing from the beginning of pregnancy to the third trimester. Although women with planned pregnancies have a higher quality of life with the onset of pregnancy, they experience similar changes compared to the other two groups.
Comparing the background characteristics of the groups, it was shown that the frequency of under-diploma education level in women with planned pregnancy was lower than the other two groups. This finding corroborates the results of other studies indicating that women's education is a determining factor in family planning [14, 15]. Nevertheless, unlike other studies [16–18], it was not a determining factor in quality of life. Additionally, contrary to the results of other studies [19, 20], the results of the present study demonstrated that economic status; number of pregnancies, and age were not related to planning for pregnancy.
Evaluation of change in HRQL over four periods of time confirmed the effect of time on the total quality of life score and its different dimensions. So that the HRQL score decreased during the first trimester, then, remained stable during the second trimester and, finally, began to decrease again after the second and during the third trimesters. This change was consistent with the situation of pregnant women during different pregnancy periods. Common problems in the 1th trimester, such as morning sickness [21], lead to lower HRQOL in this trimester.
In the 2th trimester, decrease in this sickness often results in fewer problems for women, explaining how quality of life does not change during the second trimester. Increased prevalence of pregnancy problems following an increase in abdominal enlargement, restriction of movement and sleep disorder during this period [22] is also associated with decreased quality of life. Decreased quality of life associated with the increase of gestational age has been reported previously [15], and the present study attempted to show that this change occurs even during uncomplicated pregnancies.
In line with the main objectives of this research, the results suggested that, from the outset of pregnancy, women in the unwanted pregnancy group reported lower quality of life compared to the other two groups; moreover, throughout the pregnancy, their quality of life in the environmental dimension was lower than the other two groups. Changes in overall quality of life and quality of life in physical, psychological and social dimensions followed the same pattern in all three groups. This finding suggests that, except for the environmental dimension of quality of life, other aspects are less affected by unwanted pregnancy during pregnancy; while this factor (unwanted pregnancy) has an ever-lasting impact on the environmental dimension of HRQL.
As previous studies have shown, unwanted and unplanned pregnancies can reduce quality of life in women [18]. Nonetheless, no difference was observed in the present study in the quality of life of the women with planned pregnancy and those with unplanned/wanted pregnancy. According to this finding, the wantedness of the pregnancy in the women of the study, even if not based on previous planning, does not have an adverse effect on the quality of life of these women. By contrast, unwanted pregnancy can reduce the quality of life of pregnant women.
Providing physical, psychological, social and environmental facilities is one of the conditions considered by people judging the timeliness of pregnancy. Put differently, a pregnancy is considered timely when it occurs in an appropriate condition. The environmental dimension of quality of life refers to the availability of environmental and supportive facilities [4] and, it should be noted, that differences between groups are expected at the beginning of pregnancy. But it was observed unexpectedly within the first trimester, that women with planned pregnancies experienced more decrease in the environmental dimension than women with unplanned/wanted pregnancies.
Decreased environmental quality of life during the second trimester for the women with planned and wanted pregnancies is maybe due to an incorrect estimation of conditions for planning the pregnancy. Furthermore, although perceived social support has not been measured in this study, decreased environmental quality of life in this women suggests that the available support systems have failed to decrease the problems of women during the first trimester.
One of the limitations of the present study, that needs to be taken into account in interpreting the results, is that poor pre-pregnancy quality of life can be a reason for women's unwillingness to become pregnant. Therefore, to identify the causal pathway between PC and quality of life, the pre-pregnancy quality of life of these women needs to be assessed. In addition, the low number of women with unwanted pregnancies is another limitation of the study that may affect the results of the study.