Assessment of health-promoting lifestyle habits in normal and high-risk pregnancies

Objective

We planned this study in descriptive type in order to assess health-promoting lifestyle habits in normal and high-risk pregnancies.

Methods

The population of the study consisted of all pregnant women who were receiving service at the clinic of high-risk and normal pregnancies of Konya Maternity Ward, Turkey. The size of population was calculated by power analysis as 71 individuals per group (total n=142). In order to prevent data losses, a total of 145 pregnant women were contacted. Pregnant women who volunteered to participate in the study, older than 18-year-old, who had no mental disorder and primary school graduate at least were included in the study. The data of the study was collected by sociodemographic questionnaire and Health Promoting Lifestyle Profile (HPLP) scale.

Results

The mean of total HPLP score was 117.27±24.24 in normal pregnant women, and 123.62±25.44 in high-risk pregnant women. There was no significant difference between normal and high-risk pregnancies in terms of total HPLP scores. However, there was a significant difference between two groups in terms of health responsibility (p=0.047), exercise (p=0.031) and stress management (p=0.039) subscales.

Conclusion

In this study, we evaluated the health-promoting lifestyle habits of pregnant women and the factors affecting these habits. According to the results of the study, the development of risk conditions or their pre-existence during pregnancy makes a difference in the levels of health-promoting lifestyle habits and affects them negatively.

Keywords

High-risk pregnancy, normal pregnancy, health-promoting lifestyle habit

Introduction

Pregnancy and labor are physiological processes. However, they also can be the processes full of anxiety and concerns. Physiological changes during pregnancy may narrow down the line between health and illness. Therefore, each pregnancy poses a potential risk.[1] Human body undergoes significant physiological, anatomic and biochemical changes starting with the fertilization in order to adapt to the pregnancy.[2] A woman with the high-risk pregnancy has physical, emotional and social problems. The physiological problems which pose a risk for pregnancy can be pre-existing issues before the pregnancy (such as heart disease, diabetes, hypertension) as well as problems directly developing during pregnancy (such as preeclampsia, eclampsia, hemorrhage, hypertension).[3] All pregnancies should be evaluated in terms of current and potential risk factors. Some women have particular risk factors even in the beginning of pregnancy such as diabetes or preterm labor history, which include them into the high-risk category. In other women who do not have any current risk factors, pregnancy starts normally and then risk factors such as rupture of membrane or pregnancy-induced hypertension may develop later.[4]
Health promotion is defined as the process of enabling individuals to increase control over, and to improve their health. It is fundamental to resort health-promoting habits to protect oneself from diseases, establish early diagnosis and maintain health.[5,6] According to Pender, health-promoting lifestyle habits are spiritual growth, health responsibility, exercise, nutrition, interpersonal relations and stress management.[7] The development of health-promoting lifestyle habits of pregnant women may vary according to the risk condition. We planned this study in descriptive type in order to assess health-promoting lifestyle habits in normal and high-risk pregnancies.

Methods

The population of the study consisted of all normal and high-risk pregnant women who were receiving service at the High-Risk Pregnancy Service and Pregnancy Polyclinic at Konya Maternity Ward, Turkey between January 1, 2016 and May 31, 2016. The size of the population was calculated as 71 individuals per group (total n=142) via G*Power 3.0.10 as determining the known score (121.31±21.02) with 80% power within 10-point deviation.[8] In order to prevent data losses, a total of 145 pregnant women were contacted. The data was collected by researchers via face-to-face interview method. Pregnant women who volunteered to participate in the study, older than 18-year-old, who had no mental disorder and primary school graduate at least were included in the study. The data was collected through sociodemographic questionnaire and the scale of Health-Promoting Lifestyle Profile.
The “Sociodemographic Questionnaire” consisting of 23 questions was created by the researchers through literature review to evaluate the sociodemographic characteristics of individuals.
The scale of Health Promoting Lifestyle Profile (HPLP) was developed by Walker, Sechreist and Pender in 1987 to evaluate the health-promoting habits of individuals associated with a healthy lifestyle.[9] The rating of the scale is 4-point Likert. The responses of the scales are “never” (1), “sometimes” (2), “often” (3) and “routinely” (4). The lowest score is 48 and the highest score is 192 for the entire scale. The overall score of the scale provides the score of HPLP. The alpha value of the scale, which was used by Esin (1997) in Turkey with its first version including the 48 items and evaluated for validity and reliability, was 0.91. The scale has self-actualization dimension in “Items 3, 8, 9, 12, 16, 17, 21, 23, 29, 34, 37, 44, 48”, health responsibility dimension in “Items 2, 7, 15, 20, 28, 32, 33, 42, 43, 46”, exercise dimension in “Items 4, 13, 22, 30, 38”, nutrition dimension in “Items 1, 5, 14, 19, 26, 35”, interpersonal support dimension in “Items 10, 18, 24, 25, 31, 39, 47”, and stress management dimension in “Items 6, 11, 27, 36, 40, 41, 45”.[10] In our study, we used the first version of HPLP scale consisting of 48 items which were validated for reliability by Esin.
Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, USA) was used for the statistical analysis. The data obtained in the study was presented as figure, percentage, arithmetic mean and standard deviation. After normality analyses performed on the data, t-test and one-way analysis of variance (ANOVA) tests were applied in the independent groups, and p<0.05 was considered significant.

Results

When the descriptive characteristics of the pregnant women (n=145) included in the study were analyzed, the current age of pregnant women was found 26.11±5.47 years. Of the pregnant women, the age of first marriage was 20.85±2.92 years and the age of first delivery was 22.63±3.33 years. While 49.7% of pregnant women were secondary school graduate, 84.8% of them had no job ever, 69.7% of them were living in city and 84.8% of them had health insurance. The week of gestation was 33.73±6.38. Monthly income in the family of 77.9% of the pregnant women was at medium level (incomes and expenses were equal). While 15.9% of pregnant women had consanguineous marriage, the husbands of 56.6% of pregnant women helped them for chores during pregnancy. When there was a problem associated with pregnancy, 58.6% of the pregnant women consulted healthcare professionals. The descriptive characteristics of the pregnant women and the distribution of their mean HPLP scores are presented in Table 1. There was a significant difference between mean HPLP scores of the pregnant women and their financial and social security conditions (p<0.05). There was no significant difference between other descriptive characteristics and HPLP scores (p>0.05).
The gestational characteristics of the pregnant women and their distribution according to mean HPLP scores are presented in Table 2. Of the pregnant women, 15.2% had a chronic disease. While 51% of them were on their first pregnancy (primiparous), 89% of them planned their pregnancy, and 20% of them had the history of miscarriage/abortion. Of the multiparous pregnant women (49.0%), 37.9% had normal delivery and 13.1% underwent cesarean section. A significant difference was found between gravida, planned pregnancy, history of miscarriage/abortion and HPLP scores (p<0.05).
HPLP scores and mean subscale scores of the pregnant women are presented in Table 3. Mean total HPLP score was calculated 120.42±24.96 (min=60, max=180). Considering the mean scores of HPLP subscales, it was found that “Self Actualization” subscale had the highest mean score (33.56±7.05) while “Exercise” subscale had the lowest mean score (10.25±3.68). While 50.3% (n=73) of the cases had normal pregnancy women, 49.7% (n=72) of them hospitalized in the clinic with the diagnosis of high-risk pregnancy.
Table 4 presents the diagnoses of pregnant women who were hospitalized at high-risk pregnancy clinic. In terms of the hospitalization at high-risk pregnancy clinic, 33.3% of the pregnant women were diagnosed with threat of premature birth, 12.5% of them with hemorrhage, 11.1% of them with premature rupture of membrane, 6.9% of them with oligohydramnios, 5.6% of them with preeclampsia, and 30.6% of them with other reasons (ablatio placentae, placenta previa, polyhydramnios, multiple pregnancy, imminent abortion, infection, fetal distress, hyperemesis gravidarum, hypertension, upper respiratory tract infection etc.).
Mean scores of HPLP and subscales of normal and high-risk pregnant women are compared in Table 5. Although there was no significant difference between normal and high-risk pregnancies in terms of total HPLP scores, a significant difference was found between the groups in terms of health responsibility, exercise and stress management subscales (p<0.05).

Discussion

In our study, we found that the mean age of pregnant women was 26.11±5.47 years, 49.7% of them were secondary school graduate, 84.8% of them had no job ever, and 69.7% of them were living in city. Monthly income in the family of 77.9% of the pregnant women was at medium level (incomes and expenses were equal). Saydam et al. found in their study that mean age of pregnant women was 29.54±6.26 years, 49.6% of them were primary school graduate/secondary school dropout, 84.9% of them had no job ever, 64.8% of them were living in metropolis/city, and income-expense levels of 72.3% of them were “equal”.[8] The week of gestation was 33.73±6.38. Of the pregnant women, 15.9% had consanguineous marriage. Our results show similarity with the studies in the literature.[8,11] In our study, there is a significant difference between mean HPLP scores of the pregnant women and their financial and social security conditions. There is no significant difference between other descriptive characteristics and HPLP scores. Onat and Aba found difference in their study between HPLP scores and financial conditions of pregnant women. We found a significant difference in our study between gravida, planned pregnancy, history of miscarriage/abortion and HPLP scores. Unlike our study, Onat and Aba did not find a difference in their study between HPLP score and pregnancy being planned.[11] The mean total HPLP score of the pregnant women was 120.42±24.96 (min=60, max=180). Considering the mean scores of HPLP subscales, we found that “self actualization” subscale had the highest mean score (33.56±7.05) while “exercise” subscale had the lowest mean score (10.25±3.68). The mean scores of HPLP and subscales in this study show similarity with the literature.[8,10–14]
We found significant difference in our study between normal and high-risk pregnant women in terms of health responsibility, exercise and stress management, which are the subscales of HPLP. In case of any risk condition, it is possible that the pregnant women receive care service from healthcare professionals, that there may be physical restrictions and that they may have difficulties to deal with their condition etc. We found statistically significant difference in HPLP subscales of normal and high-risk pregnant women; however, there are no great differences among the mean scores. Therefore, we believe that it is necessary to evaluate health-promoting lifestyle habits of all pregnant women identified.

Conclusion

In this study, we evaluated the health-promoting lifestyle habits of pregnant women and the factors affecting these habits. There was no significant difference between normal and high-risk pregnancies in terms of total HPLP scores in our study. However, we found significant difference between the groups in terms of health responsibility, exercise and stress management subscales. Healthcare professionals have prominent roles to encourage pregnant women for health-promoting habits. Pregnant women should be evaluated comprehensively during antenatal care, and wrong habits should be identified. Through training programs or consultancy, pregnant women and their spouses should be encouraged for health-promoting habits. There are many studies on this topic among the general population; however, there are a limited number of studies focusing on pregnancy. The number of studies carried out on pregnant women should be increased. The results of this study can be used as a reference for antenatal care, healthcare professionals and maternal/neonatal health policies.

References

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2. Erdem M. Normal gebelikteki fizyolojik değişiklikler. In: Yamaç K, Gürsoy R, Çakır N, editors. Gebelik ve sistemik hastalıklar. Ankara: Medikal & Nobel Kitabevi; 2002. p. 1–11.


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4. Qeenan JT, Hobbins JC, Spong CY. Yüksek riskli gebeliklerde tanı ve tedavi protokolleri. In: Güner H, editor. 4th ed. Ankara: Atlas Kitapçılık; 2007. p. 3–8.


5. Grace SL, Williams A, Stewart DE, Franche RL. Health-promoting behaviors through pregnancy, maternity leave, and return to work: Effects of role spillover and other correlates. Women Health 2006;43:51–72. [PubMed] [CrossRef] 


6. Ay FA. Mesleki temel kavramlar. In: Ay FA, editor. Sağlık uygulamalarında temel kavramlar ve beceriler. İstanbul: Nobel Tıp Kitabevleri; 2013. p. 15.


7. Pender NJ, Barkauskas VH, Hayman L, Rice VH, Anderson ET. Health promotion and disease prevention: toward excellence in nursing practice and education. Nurs Outlook 1992;40:106–12. [PubMed] 


8. Saydam BK, Bozkurt BÖ, Hadımlı AP, Can HÖ, Soğukpınar N. Evaluation of the effects of self care agency on health promoting lifestyle profile in pregnants at high risk. Perinatal Journal 2007;15:131–9.


9. Walker SN, Sechirst KR, Pender NJ. The Health-Promoting Lifestyle Profile: development and psychometric characteristics. Nurs Res 1987;36:76–81. [PubMed] 


10. Esin N. Sağlıklı yaşam biçimi davranışları ölçeğinin Türkçeye uyarlanması. Hemşirelik Bülteni 1999;12(45):87–95.


11. Onat G, Aba YA. Health-promoting lifestyles and related factors among pregnant women. Turkish Journal of Public Health 2014;12:69–79.


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13. Yadollahi P, Davazdahemami S, Bromandfar K, Fathizadeh N. The relationship between life style and individual reproductive characteristics of pregnant woman. Iran J Nurs Midwifery Res 2007;12:75–9.


14. Kavlak O, Atan SU, Şirin A, Şen E, Güneri SE, Dağ HY. Pregnant Turkish women with low income: their anxiety, health-promoting lifestyles, and related factors. Int J Nurs Pract 2013;19:507–15. [PubMed] [CrossRef] 

	File/Dsecription
	Table 1. The descriptive characteristics of the pregnant women and the distribution of their mean HPLP scores.
	Table 2. The gestational characteristics of the pregnant women and the distribution of their mean HPLP scores.
	Table 3. The distribution of mean HPLP and subscale scores of the pregnant women.
	Table 4. Distribution of high-risk pregnant women according to their risk conditions.
	Table 5. Comparison of HPLP and subscales of normal and high-risk pregnant women.