| Abstract
Background: Given the prevalence of infertility and consequences of stress, anxiety, and depression during
pregnancy and after childbirth, this study aimed to determine the effect of group 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.
Method: This controlled randomized clinical trial was conducted on 56 pregnant women with a history of primary
infertility referred to Infertility Clinic of Al-Zahra Teaching Hospital of Tabriz. The participants were divided into the
intervention (n = 28) and control (n = 28) groups using block randomization. The intervention group received group
CBT-based counseling after the 14th week of the pregnancy: six in-person sessions and two telephone sessions
once per week. The control group received routine 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 4 weeks after the intervention
by the researcher.
Results: There was not any between-group difference in socio-demographic characteristics, except the gestational
age and husband educational level (p > 0.05). Both of these variables were adjusted in ANCOVA. 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 |