The aim of the present study was to evaluate the PERP and its subscales as mediator of the relationship between pregnancy planning and the prenatal psychological health. Numerous studies have been conducted in evaluating the relationship between pregnancy planning and prenatal mental health, as well as the relationship between social support and prenatal mental health [28]. Nonetheless, as far as we know, the mediation of the PERP and the mental health of the woman during pregnancy have been evaluated for the first time.
The results showed that the desirable PERP, APE and RN decrease levels of depression and anxiety in the mother during pregnancy and, also, mediate the relationship between pregnancy planning and the prenatal depression and anxiety. These results indicate that to moderate the stressful pressures following unplanned pregnancy, the positive emotional reaction of the partner to the pregnancy is important.
Many studies have shown that the partner’s social support would decrease the woman’s levels of depression and anxiety during pregnancy [1, 23, 29] as well as the depression disorder [30];
Moreover, the PERP level is well-established as a major predictive factor for depressive and anxiety in pregnant women.
These findings complement the results of research showing an association between unwanted pregnancies and women's psychological health during pregnancy [13, 14]. It also confirms the results of studies that have shown that marital relationship affects the prenatal psychological health [31, 32].
Another finding of this study showed a positive relationship between planned pregnancy and the PERP. The results also showed that the depression and anxiety levels in pregnant women were inversely related to the PERP level. These findings suggest that unplanned pregnancy reduce a PERP level and thus affects the prenatal mental health. However, the lack of a direct effect of the pregnancy planning on depression and anxiety indicates that if PERP is not decreased during unplanned pregnancies, an unplanned pregnancy will not increase the depression and anxiety of pregnant women.
Previous research has shown that unplanned pregnancies are accompanied by family disruption and a decline in the marital quality and the couples' relationships; they may also be associated with a decrease in the partner's emotional support and increase the risk of the women's depression and anxiety.
It was reported that the partner's emotional reaction to pregnancy as father was one of major themes in the fatherhood development process [33]. Thus, in the pregnancy of the woman, the father’s emotional reaction to pregnancy may be considered as a message of the fatherhood development and the partner's approval of pregnancy; it may also affect the mother’s mental health. There have been reports showing the association of the unplanned pregnancy with an increased probability of not approving the pregnancy [34]. Also, some studies showed that the partner's approval of pregnancy was associated with the improvement of the woman's mental health and that the partner's disapproval would lead to depression and anxiety during the pregnancy [2, 34].
Furthermore, the present study showed that although the PERP level was less frequent among women with lower economic status, where the PERP in these families was perceived as a desirable reaction, the levels of depression and anxiety decreased in among these women. Therefore, in families with lower socioeconomic status it is necessary to teach the partner the skill of expressing positive reactions in order to improve the mental health of pregnant women in unplanned pregnancy.
Although the partner's approval of pregnancy was not directly measured in this study, the higher partner’s emotional reaction in the planned pregnancies, confirms this explanation. But the lack of direct effect of the pregnancy planning and women's mental health may suggest that having a planned pregnancy is likely to affect women's mental health, when is followed by the partner's proper reaction.
Although the present study showed that, apart from the socioeconomic status, the mental health of pregnant women depended on their perception of the PERP, there were some limitations in interpreting the results that needed to be considered. The first notable limitation was that such factors as the partner’s personality characteristics could affect the form of the couple’s relationship and probably the PERP level and women’s mental health. Additionally, because the data on the PERP and the woman’s mental health during pregnancy were collected in a cross-sectional study, we could not establish the temporal relation between the two conditions. The women’s mental health could provoke a positive behavior in their partners and might have led to the partner’s positive emotional reaction to pregnancy. Depressed women also reported more negative responses by their partners. Besides, mental disorders might affect the partner’s perceived behavior in pregnant women that cannot be examined in cross-sectional studies. However, the measurement of relationship variables such as quality, length of relationship and other family-specific variables such as time since last child has been born (if there are other children) could improve future similar studies.