Coronavirus disease (COVID-19) is an extremely infectious disease, which has been referred to as a “public health emergency” by the World Health Organization(1). The first case of COVID-19 pneumonia was reported in Wuhan City, Hubei Province, China, in December 2019. The diagnosis of COVID-19 pneumonia is based on epidemiological exposure, clinical symptoms, laboratory tests, chest computed tomography (CT) results, and a positive COVID-19 test result based on quantitative reverse transcription-polymerase chain reaction (QRT-PCR) analysis of samples taken from the respiratory system(2).
Pregnancy is a physiological condition that predisposes women to viral infections. There are concerns about the potential effects of COVID-19 infection on fetal and neonatal outcomes, and pregnant women are considered a high-risk group that requires special attention(2). Due to physiological changes in the immune and cardiopulmonary systems of pregnant women, clinical manifestations of COVID-19 infection are likely be severe during pregnancy. In 2009, pregnant women constituted 1% of all influenza A H1N1 cases, while they accounted for 5% of H1N1-related deaths(3). In addition, both the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) were the cause of serious complications during pregnancy including the need for intubation, admission to intensive care units (ICUs), kidney failure, and death(4). Several cases of pregnancy loss (miscarriage or stillbirth) have been observed in women infected with SARS-CoV and MERS and high fever during the first trimester of pregnancy can increase the risk of some birth defects(5, 6).
Extensive research on this novel coronavirus can fully clarify its transmission routes and pathogenic mechanisms and specify potential drug targets. This would help authorities develop effective preventive and therapeutic measures. Considering the rapid increase in the number of COVID-19 patients, it is very important to diagnose and isolate all suspected cases as quickly as possible to control the source of infection(7).
Public health measures are needed to control COVID-19 infection, restrict its global outbreak, and reduce relevant damages. Lack of immunity to the novel coronavirus has predisposed a large number of people to infection, and the fast global spread of the virus has led to public panic worldwide. On the other hand, prenatal psychosocial stress is quite common among mothers, and high levels of stress lead to poor pregnancy outcomes(8). Epidemics, which are often widely publicized in the mass media, are associated with high levels of stress and anxiety(9). The COVID-19 crisis increases stress levels in the general population, and since pregnancy is a potentially stressful event, this infection can cause several maternal and neonatal complications(10). According to many epidemiological studies, psychosocial stress is associated with abortion, preeclampsia, preterm delivery, low birth weight, and congenital anomalies (11–13). Prenatal stress can also lead to other complications such as hypothalamic-pituitary-adrenal (HPA) axis dysfunction, depressive symptoms (in adolescence), and asthma (in childhood)(14).
Therefore, it seems necessary to control pregnant women’s stress levels in various critical situations such as the COVID-19 pandemic. In general, an infection can be controlled through increasing public awareness, wearing protective clothes, using treatment measures, and, perhaps most importantly, vaccinating the general public. However, hospitalization, quarantine, and implementation of safety measures are critical to the containment of COVID-19 infection(15). In this regard, practical and emotional support from informal networks (families) and health professionals, clear and concise communication of necessary instructions, and simple daily physical exercises performed at home or in quarantine (to maintain mobility and reduce stress levels) can lower the increasing trend of COVID-19 infection worldwide(16).
On the other hand, self-care is the first step to help mothers, better manage their illnesses, and the health slogan of 2014, “A lifetime of health with self-care”, indicates the need to improve the self-care capabilities of all people(17). Self-care measures reduce various complications, hospital readmissions, and health costs and increase patients’ satisfaction, and their sense of control over themselves, their disease, and various symptoms. Low levels of self-care are associated with poor health outcomes(18).
Despite the widespread media coverage of COVID-19, there is still little information about the self-care performance of people, especially in high-risk groups such as pregnant women. Given the importance of this emerging disease and the necessity of communicating prevention and self-care measures, especially to vulnerable groups, we decided to conduct the present study with the aim of determining the self-care performance of pregnant women in the prevention of COVID- 19 and its relationship with their perceived stress.