The Relationship between Quality of Life and Physical Activity, Worry, Depression, and Insomnia in Pregnant Women

Depression, Insomnia, Pregnant Women, Physical Activity, Quality of life, Worry


Objective: Physical activity (PA), insomnia, depression, and worry were the key factors affecting pregnant women’s quality of life (QoL). The present study aimed to determine quality of life and its relationship with physical activity, insomnia, depression, and worry in pregnant women.

Method: This was an observational cross sectional study, conducted among 256 healthy pregnant women using 5 questionnaires: WHOQOL-brief (WHO Quality of Life Questionnaire, brief version, ISI (Insomnia Severity Index), PSWQ (Penn State Worry Questionnaire), ZSRDS (Zung Self-Rating depression Scale), and Pregnancy Physical Activity Questionnaire (PPAQ).

Results: There was a significant relationship between general QoL, insomnia, and worry with educational background, number of children, and occupation (P < 0.05). Depression had a significant relationship with occupation (P < 0.05). PA did not have a significant relationship with demographic information. However, insomnia had a significantly negative relationship with general QoL, general health, and psychological health (P < 0.05). The worry variable had also a significant negative relationship with general QoL, general health, and physiological health (P < 0.05). Depression had a significant negative relationship with general health, physical health, and psychological health (P < 0.05). There was no significant relationship between physical activities in pregnancy with QoL, depression, worry, and insomnia.

Conclusion: Women need to be informed about the necessity of controlling and reducing insomnia, worry, and depression to have a higher QoL. PA declined during the second and third trimester of pregnancy. However, PA in pregnancy can positively impact general QoL.


2. Crawford JR, Henry JD. The Depression Anxiety Stress Scales (DASS): normative data and latent structure in a large non-clinical sample. Br J Clin Psychol. 2003;42(Pt 2):111-31.
3. Eurenius E, Lindkvist M, Sundqvist M, Ivarsson A, Mogren I. Maternal and paternal self-rated health and BMI in relation to lifestyle in early pregnancy: the Salut Programme in Sweden. Scand J Public Health. 2011;39(7):730-41.
4. Tsai SY, Lee PL, Lin JW, Lee CN. Cross-sectional and longitudinal associations between sleep and health-related quality of life in pregnant women: A prospective observational study. Int J Nurs Stud. 2016;56:45-53.
5. Hajipour L, Mohtasham Amiri Z, Montazeri A, Torkan B, Hosseini Tabaghdehi M. The Effects of Prenatal Classes on the Quality of Life in Pregnant Women. Journal of Holistic Nursing And Midwifery. 2017;27(1):45-51.
6. Makvandi S, ETEMADI KA. Quality of life of pregnant women referred to health centers in Izeh (2010). JOURNAL OF KERMANSHAH UNIVERSITY OF MEDICAL SCIENCES (BEHBOOD). 2012;16(1):37-42.
7. Taylor DJ, Mallory LJ, Lichstein KL, Durrence HH, Riedel BW, Bush AJ. Comorbidity of chronic insomnia with medical problems. Sleep. 2007;30(2):213-8.
8. Bien A, Rzonca E, Kanczugowska A, Iwanowicz-Palus G. Factors Affecting the Quality of Life and the Illness Acceptance of Pregnant Women with Diabetes. Int J Environ Res Public Health. 2015;13(1):ijerph13010068.
9. Petrov Fieril K, Glantz A, Fagevik Olsen M. The efficacy of moderate-to-vigorous resistance exercise during pregnancy: a randomized controlled trial. Acta Obstet Gynecol Scand. 2015;94(1):35-42.
10. Practice ACO. ACOG Committee opinion. Number 267, January 2002: exercise during pregnancy and the postpartum period. Obstet Gynecol. 2002;99(1):171-3.
11. Ko YL, Chen CP, Lin PC. Physical activities during pregnancy and type of delivery in nulliparae. Eur J Sport Sci. 2016;16(3):374-80.
12. Huberty JL, Buman MP, Leiferman JA, Bushar J, Adams MA. Trajectories of objectively-measured physical activity and sedentary time over the course of pregnancy in women self-identified as inactive. Prev Med Rep. 2016;3:353-60.
13. Hamilton K, Fleig L, Henderson J, Hagger MS. Being active in pregnancy: Theory-based factors associated with physical activity among pregnant women. Women & health. 2019;59(2):213-28.
14. Todorovic J, Terzic-Supic Z, Bjegovic-Mikanovic V, Piperac P, Dugalic S, Gojnic-Dugalic M. Factors Associated with the Leisure-Time Physical Activity (LTPA) during the First Trimester of the Pregnancy: The Cross-Sectional Study among Pregnant Women in Serbia. Int J Environ Res Public Health. 2020;17(4):1366.
15. Vargas-Terrones M, Nagpal TS, Barakat R. Impact of exercise during pregnancy on gestational weight gain and birth weight: an overview. Braz J Phys Ther. 2019;23(2):164-9.
16. Dorheim SK, Bjorvatn B, Eberhard-Gran M. Insomnia and depressive symptoms in late pregnancy: a population-based study. Behav Sleep Med. 2012;10(3):152-66.
17. Osnes RS, Roaldset JO, Follestad T, Eberhard-Gran M. Insomnia late in pregnancy is associated with perinatal anxiety: A longitudinal cohort study. Journal of Affective Disorders. 2019;248:155-65.
18. Sharma SK, Nehra A, Sinha S, Soneja M, Sunesh K, Sreenivas V, et al. Sleep disorders in pregnancy and their association with pregnancy outcomes: a prospective observational study. Sleep and Breathing. 2016;20(1):87-93.
19. Polo‐Kantola P, Aukia L, Karlsson H, Karlsson L, Paavonen EJ. Sleep quality during pregnancy: associations with depressive and anxiety symptoms. Acta obstetricia et gynecologica Scandinavica. 2017;96(2):198-206.
20. Okun ML, O'Brien LM. Concurrent insomnia and habitual snoring are associated with adverse pregnancy outcomes. Sleep Med. 2018;46:12-9.
21. Statham H, Green JM, Kafetsios K. Who worries that something might be wrong with the baby? A prospective study of 1072 pregnant women. Birth. 1997;24(4):223-33.
22. Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004;130(4):601-30.
23. 2Goodwin H, Yiend J, Hirsch CR. Generalized Anxiety Disorder, worry and attention to threat: A systematic review. Clinical Psychology Review. 2017;54:107-22.
24. Ma X, Wang Y, Hu H, Tao XG, Zhang Y, Shi H. The impact of resilience on prenatal anxiety and depression among pregnant women in Shanghai. Journal of Affective Disorders. 2019;250:57-64.
25. Moraes EV, Campos RN, Avelino MM. Depressive Symptoms in Pregnancy: The Influence of Social, Psychological and Obstetric Aspects. Rev Bras Ginecol Obstet. 2016;38(6):293-300.
26. Sut HK, Asci O, Topac N. Sleep Quality and Health-Related Quality of Life in Pregnancy. J Perinat Neonatal Nurs. 2016;34(4):302-9.
27. de Wit L, Jelsma JG, van Poppel MN, Bogaerts A, Simmons D, Desoye G, et al. Physical activity, depressed mood and pregnancy worries in European obese pregnant women: results from the DALI study. BMC Pregnancy Childbirth. 2015;15:158.
28. Gholami A, Jahromi LM, Zarei E, Dehghan A. Application of WHOQOL-BREF in Measuring Quality of Life in Health-Care Staff. Int J Prev Med. 2013;4(7):809-17.
29. Zarei S, Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Effati-Daryani F, Shiri-Sarand F. Predictors of Quality of Life in Pregnant Women Visiting Health Centers of Tabriz, Iran. Journal of Midwifery and Reproductive Health. 2018;6(2):1223-9.
30. Nejat S, Montazeri A, Holakouie Naieni K, Mohammad K, Majdzadeh S. The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. Journal of School of Public Health and Institute of Public Health Research. 2006;4(4):1-12.
31. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): Translation and validation study of the Iranian version. Quality of Life Research. 2005;14(3):875-82.
32. Smith MT, Wegener ST. Measures of sleep: the insomnia severity index, medical outcomes study (MOS) sleep scale, Pittsburgh sleep diary (PSD), and Pittsburgh sleep quality index (PSQI). Arthritis Care & Research. 2003;49(S5).
33. Amini H, Sharifi V, Asadi S, Mohammadi MR, Kaviani H, Semnani Y, et al. Validity of the Iranian version of the structured clinical interview for DSM-IV (SCID-I) in the diagnosis of psychiatric disorders. PAYESH.2008;7(1):49-57.
34. Yazdi Z, Sadeghniiat-Haghighi K, Zohal MA, Elmizadeh K. Validity and reliability of the Iranian version of the insomnia severity index. Malays J Med Sci. 2012;19(4):31-6.
35. Meyer TJ, Miller ML, Metzger RL, Borkovec TD. Development and validation of the Penn State Worry Questionnaire. Behav Res Ther. 1990;28(6):487-95.
36. Salarifar M, Pouretemad H. P-1060-The study of factorial structure, validity and reliability of the penn state worry questionnaire (PSWQ). European Psychiatry. 2012;27:1.
37. AlDukhayel A. Prevalence of Depressive Symptoms among Hemodialysis and Peritoneal Dialysis Patients. Int J Health Sci (Qassim). 2015;9(1):9-16.
38. Rashedi V, Rezaei M, Foroughan M, Delbari A. Validity and reliability of the depression in old age scale (DIA-S) in Iranian older adults. Arch Gerontol Geriatr. 2016;66:193-7.
39. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9 Suppl):S498-504.
40. Bahadoran P, Mohamadirizi S. Relationship between physical activity and quality of life in pregnant women. Iran J Nurs Midwifery Res. 2015;20(2):282-6.
41. Mourady D, Richa S, Karam R, Papazian T, Hajj Moussa F, El Osta N, et al. Associations between quality of life, physical activity, worry, depression and insomnia: A cross-sectional designed study in healthy pregnant women. PLoS One. 2017;12(5):e0178181.
42. Mourady D, Richa S, Karam R, Papazian T, Hajj Moussa F, El Osta N, et al. Associations between quality of life, physical activity, worry, depression and insomnia: A cross-sectional designed study in healthy pregnant women. PLoS One. 2017;12(5):e0178181.
43. Lau Y, Yin L. Maternal, obstetric variables, perceived stress and health-related quality of life among pregnant women in Macao, China. Midwifery. 2011;27(5):668-73.
44. Cunha A, Akerman L, Rocha A. Stress and Anxiety in Pregnant Women from a Screening Program for Maternal-Fetal Risks. J Gynec Obstet. 2017;1:013.
45. Mindell JA, Cook RA, Nikolovski J. Sleep patterns and sleep disturbances across pregnancy. Sleep Med. 2015;16(4):483-8.
46. Roman-Galvez RM, Amezcua-Prieto C, Salcedo-Bellido I, Martinez-Galiano JM, Khan KS, Bueno-Cavanillas A. Factors associated with insomnia in pregnancy: A prospective Cohort Study. Eur J Obstet Gynecol Reprod Biol. 2018;221:70-5.
47. Effati-Daryani F, Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Shiri-Sarand F, Zarei S. Sleep quality and its relationship with quality of life in Iranian pregnant women. Int J Nurs Pract. 2017;23(2).
48. Ertel KA, Silveira ML, Pekow PS, Dole N, Markenson G, Chasan-Taber L. Prepregnancy body mass index, gestational weight gain, and elevated depressive symptoms in a Hispanic cohort. Health Psychol. 2015;34(3):274-8.
49. Richardsen KR, Mdala I, Berntsen S, Ommundsen Y, Martinsen EW, Sletner L, et al. Objectively recorded physical activity in pregnancy and postpartum in a multi-ethnic cohort: association with access to recreational areas in the neighbourhood. Int J Behav Nutr Phys Act. 2016;13:78.
50. Santos PC, Abreu S, Moreira C, Santos R, Ferreira M, Alves O, et al. Physical Activity Patterns During Pregnancy in a Sample of Portuguese Women: A Longitudinal Prospective Study. Iran Red Crescent Med J. 2016;18(3):e22455.
51. Johansson K, Hutcheon JA, Bodnar LM, Cnattingius S, Stephansson O. Pregnancy weight gain by gestational age and stillbirth: a population-based cohort study. BJOG. 2018;125(8):973-81.
52. Evenson KR, Bradley CB. Beliefs about exercise and physical activity among pregnant women. Patient Educ Couns. 2010;79(1):124-9.
53. Moore I, Madraswalla M, Mason M, O'Sullivan D, Johnson A. Patterns of Exercise and Physical Activity in Pregnant Women [11N]. Obstetrics & Gynecology. 2018;131:154S-5S.
54. Montoya Arizabaleta AV, Orozco Buitrago L, Aguilar de Plata AC, Mosquera Escudero M, Ramirez-Velez R. Aerobic exercise during pregnancy improves health-related quality of life: a randomised trial. J Physiother. 2010;56(4):253-8.
55. Kolu P, Raitanen J, Luoto R. Physical activity and health-related quality of life during pregnancy: a secondary analysis of a cluster-randomised trial. Matern Child Health J. 2014;18(9):2098-105.
56. Poudevigne MS, O'Connor PJ. A review of physical activity patterns in pregnant women and their relationship to psychological health. Sports Med. 2006;36(1):19-38.
57. Setse R, Grogan R, Pham L, Cooper LA, Strobino D, Powe NR, et al. Longitudinal study of depressive symptoms and health-related quality of life during pregnancy and after delivery: the Health Status in Pregnancy (HIP) study. Matern Child Health J. 2009;13(5):577-87.
How to Cite
Adham D, Abazari M. The Relationship between Quality of Life and Physical Activity, Worry, Depression, and Insomnia in Pregnant Women. Iran J Psychiatry. 15(2):159-168.
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