Although the effect of COVID-19 on pregnant women is still unclear, there are concerns about its potential impact on maternal and perinatal outcomes due to suppression of the immune system during pregnancy . However, few studies have been conducted on perceived risk and protective behaviors among pregnant women during the COVID-19 pandemic. The present study addressed this important issue and measured the level of risk perception, knowledge level, and protective behaviors of pregnant women, as well as the relevant determinants.
The present study showed that the level of knowledge related to the COVID-19 and its transmission and prevention was high among pregnant women, so this level of awareness about the symptoms of the disease, and in particular the ways in which it is transmitted, has been almost above 95%. It seems that the awareness of pregnant women, both through the mass media and by health care providers, has increased significantly. In a study by Nwafor et al., 60.9% of pregnant women had sufficient knowledge of preventive measures against COVID-19 . Yassa et al., in their study on pregnant women near childbirth, found that pregnant women have a positive attitude toward quarantine. At the same time, they expressed their progressive anxiety and concern for the pregnancy and the baby due to the pandemic and also believed that they had been given insufficient counseling or limited information about the relationship between pregnancy and pandemic .
In the present study, the majority of pregnant women [about 62%] believed that the general population should use masks to prevent disease; nearly 29% opposed it, and about 10% said they were unaware. It should be acknowledged that the unknown nature of COVID-19, and even its transmission, along with the different policies of different countries on disease protection, can have a significant impact on people’s responses. Besides, researchers have noted the sensitivity and concern of pregnant women about their vulnerability to infectious diseases. For example, an interview study conducted during the H1N12009 Influenza pandemic revealed that the individuals most concerned for the possibility of getting infected or transmitting the virus to others were pregnant women and those with young children [26, 27]. In the present study, 32% of pregnant women did not know that children could also develop COVID-19. About 40% of women did not know that the disease could not be treated with common antiviral drugs, and about 45% of pregnant women thought that the flu vaccine could be given every year to prevent the COVID-19. While the clinical evidence was growing rapidly, this data may guide to perceive what accurate information should be provided to pregnant women.
Our results showed that more than half of pregnant women obtained their information through TV. Similar to our findings, other studies reported that participants usually obtained their information about infectious diseases through the internet and watching TV. Olapegba and Ayandele in a study in Nigeria reported that traditional media [TV/radio] was the source of information regarding COVID-19 for more than 93.5% of people . In a similar manner, Sasaki et al. found that television, the Internet, and newspapers were the most common sources of information about the H1N1 outbreak . According to our study, women with a university education were significantly more aware of the disease than women with less education. In the recent study of Nwafor et al., one of the factors associated with inadequate knowledge of preventive measures regarding COVID-19 was no formal education . The level of knowledge of pregnant women who had more children was significantly higher, and although nonsignificant, their risk perception was lower and their preventive behavior was better. Contrary to our study, in the study of Nwafor et al., pregnant African women who had given birth five or more times had lower levels of awareness about preventive measures related to COVID-19 . The greater awareness of pregnant women with a previous history of influenza in the present study can be related to the increased sensitivity of this group of women to the risk of contracting viral diseases during pregnancy and its complications.
Pregnant women in our study reported high levels of protective behaviors related to COVID-19. It seems that during acute conditions such as epidemics, due to extensive training and information transition, high preventive behavior can be expected from individuals. In the USA, over the course of a few days, people became increasingly aware of the dangers of COVID-19 and performed well on protective behaviors . In our study, pregnant women with better economic status had better protective behaviors. In a study by Chandrasekaran et al. , knowledge and behavior related to Zika disease were lower in women with poor economic status compared to women with moderate to high status. Therefore, special attention should be paid to women with low economic status, especially during pandemics.
Nulliparous women in our study had a higher level of risk perception related to COVID-19 than multiparous women. Similar to the risk perception in other fields, pregnancy risk perception is highly individualized and several factors may influence the perception of pregnancy risk . Risk perception is the subjective response based on previous life experiences, coping strategies, the context in which the risk occurs, and the degrees the risk obtained from a variety of sources . Little is known about how risk impacts a woman’s perception and experience of pregnancy . However, it seems that the experience of pregnancy and childbirth can reduce the perceived risk.
The results of the present study showed that risk perception can predict preventive behaviors significantly. In contrast to our study, Taghrir et al., in the recent study on the medical students, reported a negative correlation between preventative behaviors and risk perception related to COVID-19 . Risk perception as a determinant of protective behaviors is often positively associated with preventative behaviors, although in some cases negative interactions with preventive behaviors have been shown, for example, when the perception of risk is high, but the chance of success in dealing with it is considered low, preventive behaviors are reduced .
The main strong point of the present study is addressing pregnant women as a vulnerable group during the COVID-19 pandemic. Yet, the causal relationships among the variables could not be assessed due to the cross-sectional design of the study.