Pregnancy is often a stressful time with physiological and psychological changes [1]. Many women may be at risk for pregnancy which could endanger their health and that of their child. Among them, we can mention the high age of the mother (35 years or more) in pregnancy, which as a risk factor increases the concerns of pregnant women [3].
Pregnancy at age 35 or older increases the risk of pregnancy complications such as high blood pressure, preeclampsia, diabetes, placenta previa, cesarean section, obstetric interventions, and adverse perinatal outcomes (such as stillbirth) [7-4].
Health behaviors or practices in which the mother is involved can affect the consequences of pregnancy. Maternal factors that can affect the pregnancy are activity and rest, type of nutrition, coping with stress, pregnancy care - form part of a pregnant mother's lifestyle and health function [9].
In the field of health education, by using educational models designed to explain the factors related to behavior, appropriate strategies for adopting preventive behavior and promoting self-care behaviors in pregnant women can be provided [13].
Research shows that training individually and in groups increases one's self-knowledge, attitudes, and care skills [15]. It reduces childbirth and subsequent problems [16]. Given that pregnancy at the age of 35 or older is a high-risk pregnancy and requires more care to prevent complications, and since self-care education can lead to appropriate preventive behaviors, this study aims to determine the effectiveness of counsel for self-care on health function in pregnant women aged 35 years or older.

 

This study is a semi-experimental two-group intervention (test and control) with pre-test-post-test design that has been performed as a clinical trial on 100 pregnant women aged 35 years and older who referred to Hamadan Comprehensive Health Centers in 2018 to receive pregnancy care. To conduct this research, the comprehensive health centers of Hamadan city were divided into 4 geographical areas and 4 clinics from each region were randomly selected. The researcher then randomly assigned 8 of the 16 clinics to the test group and 8 to the control group. The study population was all 35-year-old pregnant women and older who had applied for maternity care, and the study sample was 35-year-old pregnant women and older who met the criteria to enter the study. Criteria for entering the study included having age 35 or more during pregnancy, lack of underlying disease, singleton pregnancy, gestational age over 24 weeks, initial and higher literacy, and complete health based on the medical record. The criteria for leaving the study included missing more than one session of the training classes and the incidence of pregnancy-related complications. The sample size was obtained using the research of Bastani et al. [17] and taking into account the error of the first type of 5%, the test power of 80% and the 10% probability of the sample loss for each group.
Data gathering tools were Health Practices in pregnancy Questionnaire-II (HPQ-II) (and demographic questionnaire. The validity and reliability of the questionnaires were assessed. In this study, Cronbach's alpha was 0.79.
Data analysis was first performed using statistical tests of Chi-square, Fisher test, independent t-test, paired t-test and using SPSS 20 (SPSS Inc., Chicago, Ill., USA). A P-value less than 0.05 was considered significant.

According to the results, the mean scores of health practices in the test group before and after the intervention changed from (110.38±20.41) to (120.82±19.36) and the difference was statistically significant (P<0.05), while in the control group changed from (112.12±20.91) to (113.54±16.33) and the difference was not statistically significant (P>0.05).
 

Table 1. Comparison of demographic characteristics and number of pregnancies of research units in two control and test groups

*P-value less than 0.05 was considered significant.

Table 2. Comparison of the average scores of total health performance before and after the intervention between the two groups of test and control

Table 3. Comparison of the average scores of total health performance before and after the intervention using paired t-test in two groups of test and control

The study included counseling on the performance of pregnant women. The difference in mean health score before and after the intervention between the test group and the control was statistically significant. Also, these averages in the intervention group before and after the consultation were significantly different. Therefore, it can be concluded that counseling affects the performance of health in pregnancy and improves this variable, ie self-care counseling on the performance of pregnant women such as: rest and activity, care for diseases and injuries, nutrition and diet care, avoidance of drugs. Trauma, health care follow-up, and awareness of pregnancy and childbirth have had a positive effect. These findings are consistent with the findings of Rezvani et al.
According to other research, education and counseling improve people's performance. Among these studies are the findings of Ghafourifard and Ebrahimi, Mahmoudzadeh-Zarandi et al. [24, 23].

 

The present study showed the health practices of maternal aged in high risk pregnant women.

 

This research is the result of a master's thesis approved by Hamadan University of Medical Sciences with the code of ethics IR.UMSHA.REC.1396.484. We would like to express our sincere gratitude to the Vice Chancellor for Research of Hamadan University of Medical Sciences and all those who participated in this research.

 

The authors declared no conflict of interest regarding the publication of this article.