DISCUSSION:

We investigated the QOL of 164 women during pregnancy, a period in which

significant changes occur physically and emotionally, to manifest the role of
Health-related quality of life among those women and to aware them about its
importance. In the present study we used WHOQOL-BREF to investigate quality of
life in the pre-natal period as well as significant factors associated with it. The
Alpha Cronbach coefficient value calculated for the subscales of the WHOQOL-
BREF indicated its high level of internal consistency in all three trimesters, good
evaluation of their QOL. We had participants of all three trimesters equally,
Majority of women were of age between 17 and 36, were married for more than
five years, had two or more gravida and birth order 1. Also, most of them went to
high school and around one third of them were highly educated, very few of them
reported any illness. We assessed the quality of life of pregnant women in four
domains i.e. Physical, environmental, psychological and social, the study resulted
in mean scores (54.23, 59.93, 62.72, 51.94) respectively. According to the results
of the World Health Organization Quality of Life (WHOQOL BREF) Research, the
mean scores of physical, psychological, social and environment domains for
healthy women were found to be 13.4, 14 14.0, 14.1, 13.5 respectively (37) and
14.5, 13.9, 15.3, 13.5 respectively in a study conducted on healthy 21 women in
Turkey, (38) whereas a study conducted in Hazara resulted in (95.00, 79.64, 48.03,
126.30) respectively. (39). As we investigated their quality of life in those four
domains we found out that majority of women had better quality of life in social
domain followed by physical then psychological, majority reported lowest quality
of life in environmental domain. This study is consistent with study of Lagadec et
al. that says that higher quality of life is attributed to social factors. (1) As
pregnancy is a motivating event, women are encouraged which is a good
sign of her quality of life and mental well-being. (41,42) When she gets social
support from her family and friends who take care of her diet, physical and
mental comfort, medication and provide her with adequate moral support
she is motivated to take care of herself which is a true indicator of her
HRQoL. (43-45). A study by Makvandi et al. concludes that the lowest score of
life quality in pregnant women is related to vitality sensation dimensions and
limitations of performance and are due to physical problems (15) a study in
Kashan, Iran states the same (35) Whereas, according to our findings lowest score
was found to be related to environmental factors.
 As we compared the variables used in our questionnaire and tried to find their
associations with the Health-related quality of life, we found out that those
women who were more educated had improved quality of life in all domains
especially in environmental one. For this variable of ‘education’ there was inverse
correlation found with the reference variable ‘uneducated’ in two domains i.e
physical and psychological which means that those women who were highly
educated reported to have poor quality of life physically and psychologically,
however, this seems not to be true for other two domains and those women
reported good quality of life in terms of social and environmental health. These
results are closer to the results of a study published in 2009 that was
conducted in Islamabad to assess the HRQOL in urban vs. rural areas,
they found that since in urban areas there’s much more access to health
care professionals and education urban people have a better lifestyle
during the pregnancy (10) A study conducted by Fatemeh A et al. found
significant positive statistical correlation between different levels of
education and dimensions of physical functioning and mental health.
Especially, pregnant women with high school diploma or higher educational
level showed greater average scores than those with lower level of
education.
In terms of age, we found that women of greater age reported better quality of
life than younger ones in all domains except for the physical one. Using univariate
analysis, a significant and inverse correlation was found between age and quality
of life in physical health domain and the other domains remained unaffected and
women with greater age reported overall good quality of life. This finding is in
contrast with an Iranian study which says that Quality of life is best in younger
(15±29 years) and worst in elderly subjects (over 50 years). Quality of life
decreased with increment in age. (2)
In a study conducted in Slovak republic, On the average score basis, achieved in a
range of quality life, there were no significant differences in age-based averages.
The highest quality of life was demonstrated in young women, then middle and
lowest in women of older age, but statistically significant differences in effects of
age on the quality of life of pregnant women were not demonstrated (13)
According to the study of Balíková and Bužgová [36], quality of life in pregnant
women was assessed by the SF-12 questionnaire, a statistically significant
difference in the quality of life according to age (P = 0.020) was detected. Women
of age over 29 years reported lower quality of life than younger.

We analyzed the impact of gestational age of pregnancy on life quality of

women. Results showed that women in third trimester had the lowest quality of
life than the women in first trimester in physical domain, same results obtained
for other domains as well but those associations were not statistically significant.
This study is in consistent with an Iranian study which says that Physically, the
quality of life decreased significantly during the course of the trimesters. On a
psychological level, several studies reported an increase in quality of life relative
to mental health during pregnancy, and in others psychological stability was
seen. (1) . According to the research of Mazúchová L et al, the best period of
pregnancy from this aspect is expected to be the second trimester and a more
demanding period is first and mainly third trimester. (13) Moreover, the study
carried out by Otchet et al showed that women who were normal and in the third
trimester reported a poorer functional level related to health. (40)
For variables such as gravida and birth order we found that with their
increasing number, quality of life was decreasing since results are not statistically
significant, further studies (i.e higher n) are needed to verify it. Participants with
gravida 2 and more had lower quality of life in all domains except environmental
one than those participants with gravida 1. Study by Mazúchová L et al. analyzed
differences in the quality of life by parity. The average score achieved in a range
of quality of life has been shown to be the best in the birth order 3, then for 2 and
finally in the Firstborn (13) however our findings show inverse relationship
between quality of life and birth order. A study by Abujilban S et al. says that
pregnant women with lesser number of children reported more satisfaction
with their lives. (18) According to a study in Iran, As far as gravidity is
concerned, the average scores of all dimensions except body pain and
functional limitations due to emotional issues in women who were
expectant with first pregnancy were greater than women on their second or
subsequent pregnancies. (35)
Moreover, participants who had any sort of illness reported low quality of life in
all domains except for social health. Consistent study found in American Journal
of Obstetrics and Gynecology says that burden of illness on a pregnant woman
such as nausea and vomiting pregnancy can severely affect a woman's QOL
and ability to function negatively. According to another study consistent
with our finding, further elaborates that, Critical illness may result from
worsening of pre-existing diseases induced by pregnancy. And reversely
Pregnancy can also predispose women to diseases that are found in the
non-pregnant population (47) Any contrast studies which says that illness
has no impact over quality of life of pregnant women were not found.
According to one of our findings, Participants with marriage period above four
years reported to have low quality of life in all domains. No comparable studies
were found in this aspect.
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