Original Article

The Effect of Prenatal Self‑Care Based on Orem’s Theory on Preterm

Birth Occurrence in Women at Risk for Preterm Birth

Abstract Seyedeh-
Background: Preterm birth is increasing as a major cause of perinatal complications and mortality Mahboobeh
in Iran. The present study aimed to investigate the effect of prenatal self‑care based on Orem’s Rezaeean1,
theory on preterm birth occurrence in women at risk for preterm birth. Materials and Methods: The
present clinical trial was conducted on 176 pregnant women at 24–26 weeks at risk for preterm birth Zahra Abedian2,3,
in Mashhad, Iran, from December 2015 to October 2016. A multistage sampling method was used Robab Latifnejad-
in this study. The intervention group (88 pregnant women) received individual self‑care education Roudsari2,3,
but the control group (88 pregnant women) received only common prenatal care. Results: There Seyed-Reza
was a statistically significant difference between intervention and control groups in terms of preterm Mazloum2,4,
birth occurrence (6.80% vs 20.50%) ( 2 = 6.90, df = 1, p = 0.008). The incidence of preterm birth
in the intervention group was approximately three times higher than that in the control group. Zohreh Abbasi1
Conclusions: Given that educational interventions could reduce the incidence of preterm birth, it is
1
Department of Midwifery,
suggested that the women at risk for preterm birth are trained for prenatal self‑care. Medical Faculty, North
Khorasan University of Medical
Keywords: Iran, premature birth, self care Sciences, Bojnurd, Iran,
2
Nursing and Midwifery Care
Research Center, Mashhad
University of Medical Sciences,
Introduction self‑care theory is one of the most important Mashhad, Iran, 3Department of
theories on self‑care education.[14] There are Midwifery, School of Nursing
According to the World Health Organization
three types of self‑care requisites including and Midwifery, Mashhad
(WHO), preterm labor is defined as giving University of Medical Sciences,
universal self‑care requisites, developmental
birth before 37 weeks (259 days) from the Mashhad, Iran, 4Department
self‑care requisites, and health deviation of Medical Surgical Nursing,
1st day of the last menstruation.[1] Preterm self‑care requisites.[13,15] Universal self‑care School of Nursing and
birth affects approximately 11% of births requisites are found in all humans and are Midwifery, Mashhad University
worldwide.[2] Preterm birth has increased associated with processes of individuals’ of Medical Sciences, Mashhad,
in Iran from 6.7% in 1996 to 12.1% in lives and general welfare.[16] Universal
Iran
2000 and 16.4% in 2003.[3] Preterm birth self‑care deficits in pregnancy include
is a major cause of perinatal morbidity malnutrition in pregnancy,[6] alcohol
and mortality.[4] According to the findings usage, drug use, inadequate intake of
of various studies, the poverty, maternal healthy air in situations where there is
age of under 20 and over 36 years, short smoking,[17] ambient poisons,[5] sulfur
interval between pregnancies, preeclampsia, dioxide,[18] imbalance between activity
addiction, some drugs,[5] malnutrition,[6] and rest such as prolonged standing and Address for correspondence:
hyperemesis gravidarum,[7] infection, Mrs. Zahra Abedian,
walking,[19] intense physical activity and Nursing and Midwifery Care
inflammation, and maternal body mass
[8]
night work,[20] occupational tiredness,[10] Research Center, Mashhad
index affect the incidence of preterm risks for pregnant women during pregnancy University of Medical Sciences,
birth.[9] The social support, relationships, Mashhad, Iran. Department of
such as hitting,[21] anxiety,[22] depression,[23] Midwifery, School of Nursing
and self‑care have also been considered stress, and lack of social support and and Midwifery, Mashhad
as factors involved in the incidence of relationships.[5] These cases are among University of Medical Sciences,
preterm birth.[10] The self‑care program the predisposing factors for the incidence Mashhad, Iran.
for pregnant women is an effective way to E‑mail: abedianz@mums.ac.ir
of preterm birth. Developmental self‑care
prevent preterm birth and is recommended requisites emerge at different stages of
for all pregnant women.[11] Self‑care is the life including adolescence, pregnancy, Access this article online
care undertaken by individuals to improve and aging.[16] Developmental self‑care
Website: www.ijnmrjournal.net
life, health, and well‑being.[12,13] Orem’s
DOI: 10.4103/ijnmr.IJNMR_207_19
How to cite this article: Rezaeean SM, Abedian Z, Quick Response Code:
This is an open access journal, and articles are Latifnejad‑Roudsari R, Mazloum SR, Abbasi Z. The
distributed under the terms of the Creative Commons effect of prenatal self‑care based on Orem’s theory
Attribution‑NonCommercial‑ShareAlike 4.0 License, which on preterm birth occurrence in women at risk for
allows others to remix, tweak, and build upon the work preterm birth. Iranian J Nursing Midwifery Res
non‑commercially, as long as appropriate credit is given and the
2020;25:242-8.
new creations are licensed under the identical terms.
Submitted: 02-Sep-2019. Revised: 23-Nov-2019.
For reprints contact: reprints@medknow.com Accepted: 02-Mar-2020. Published: 18-Apr-2020.

242 © 2020 Iranian Journal of Nursing and Midwifery Research | Published by Wolters Kluwer - Medknow
 Rezaeean, et al.: Effect of prenatal self‑care on preterm birth

deficits during pregnancy include short interval between comparing means were used at 95% confidence interval,
pregnancies,[3] number of pregnancies, inappropriate weight 80% test power, Z1‑α/2 = 1.96, Z1‑β =0.84, X1 = 38, X2 = 37,
gain during the pregnancy, and lack of adequate prenatal S1 = 1 and S2 = 3 in order to estimate sample size due to the
care which are associated with an increased risk of preterm lack of similar study. The sample size was 78 in each group
birth.[5] Health deviation self‑care requisites occur due and 156 in total. The final sample size was determined
to diseases, genetic and physical defects, and structural by adding 15% (90 participants in each group and
and functional deviations in humans.[16] Health deviation 180 in total) to compensate for dropout [Figure 1].
self‑care deficits in pregnancy include medical and obstetric A multistage sampling method was used in this study. The
diseases including bacterial vaginosis,[24] anemia,[25] five main urban health centers and 180 smaller subsidiary
short cervical length,[26] pyelonephritis, preeclampsia, health centers were determined as the sampling frame. The
oligohydramnios, polyhydramnios, placenta previa, five main urban health centers were selected using stratified
third‑trimester hemorrhage, anatomic abnormality of uterus, random sampling, and then subsidiary health centers were
diabetes mellitus, thyroid dysfunction, and cardiac disease selected using cluster sampling. In each center, the subjects
of mothers,[5] which could also be associated with preterm were selected conveniently. A total of 24 health centers
birth. Evidence shows that pregnant women’s lifestyles were selected, from which 12 centers were assigned to the
including their self‑care could be related to the preterm birth intervention group and 12 ones to the control group.
occurrence.[10] Therefore, it seems that teaching self‑care The data collection instruments included a questionnaire for
to mothers who are at risk for preterm birth can reduce demographic and obstetric characteristics, the Holbrook’s
the incidence of preterm birth.[27] However, there are some preterm delivery screening questionnaire, and the Hart
other reports that do not confirm the significant relationship Prenatal Care Actions Scale (HPCAS). The questionnaire
between lifestyle and prenatal care with preterm birth.[28] for demographic and obstetric characteristics included
This controversy suggests the need for further studies on the 26 questions that were completed by the subjects at the
impact of self‑care on the incidence of preterm birth. beginning of the study. The Holbrook’s preterm delivery
Given the importance of preterm birth as well as the screening questionnaire included three sections: risk
significance of self‑care in pregnant mothers and the lack factors, sub‑risk factors, and underlying risk factors. The
of access to available evidence about the effect of self‑care first section consisted of 14 questions, the second section
behaviors on the incidence of preterm birth in Iran, this includes 14 questions, and the third section comprised
study sought to investigate the effect of prenatal self‑care 12 questions. The first section questions receive score 10,
based on Orem’s theory on preterm birth occurrence in the second section receives score 5, and the third section
Iranian women at risk for preterm birth. receives score 2.5. If individuals scored 10 or more, they
were considered as a high‑risk group, and if they scored
Materials and Methods lower than 10, they were considered as a low‑risk group
The present clinical trial study (IRCT2015122225659N1) for the preterm birth.[27] HPCAS was developed by Hart.
was derived from a master thesis in Midwifery and it was HPCAS consisted of 41 items that were derived from the
performed on 176 pregnant women at risk for preterm universal self‑care requisites and articulate the guidelines
birth (88 participants in the intervention group and for prenatal care.[21] HPCAS is a Likert type scale with
88 participants in the control group) in Mashhad, Iran, five responses ranging from “never” to “always.” Scores
from December 2015 to October 2016. The participants can range from 41 to 205 with a higher score indicating
consisted of all pregnant women at risk for preterm birth increased engagement in prenatal care actions.[21] The
referring to health centers affiliated to Mashhad University validity of this questionnaire was approved by Sea‑han.[29]
of Medical Sciences, Mashhad, Iran. The inclusion criteria The Farsi version of HPCAS (passing the translation and
back‑translation process by professional translators) was
included: being Iranian and resident of Mashhad; having
also validated through the content validity in the present
at least reading and writing literacy for understanding and
study. The reliability of HPCAS was confirmed with a
answering the questions; willingness to participate in the
Cronbach’s alpha of 80% by Sae‑han.[29] The reliability
study; gestational age of 24–26 weeks based on the accurate
of the Farsi HPCAS was estimated to be 76.20% using
and reliable Last Menstrual Period (LMP) or ultrasound
Cronbach’s alpha formula.
results at the first 3 months of pregnancy; score 10 or more
in Holbrook’s preterm delivery screening questionnaire; The entire sampling process lasted 11 months. To recruit
no speech, hearing, or accent disorder which prevent the participants, firstly, objectives and methods of the
communication with the researcher; and previous or current study and the issue of confidentiality were explained to
incidence of psychological problems. Exclusion criteria at the participants. Written consent was also obtained from
the end of the study were as follows: not attending three the participants before taking part in the study. Then,
sessions of education and not responding fully to the eligible participants completed the preterm labor screening
questionnaires. Results of the pilot study on 30 pregnant questionnaire and those scoring 10 or higher were allocated
women (15 participants in each group) and a formula for to the intervention group (mothers at risk of preterm birth

Iranian Journal of Nursing and Midwifery Research ¦ Volume 25 ¦ Issue 3 ¦ May-June 2020 243
 Rezaeean, et al.: Effect of prenatal self‑care on preterm birth

Enrollment Assessed for eligibility (n = 300)

Excluded (n = 120)
• Not meeting inclusion criteria
(n = 120)

Randomized (n = 180)

Allocation
Allocated to intervention (n = 90) Allocated to control (n = 90)

Follow-Up

Lost to follow-up (n = 2) Lost to follow-up (n = 2)

Reason: Not attending three sessions Reason: Not responding fully to the
of education questionnaires

Analysis
Analysed (n = 88) Analysed (n = 88)
• Excluded from analysis (n = 2) • Excluded from analysis (n = 2)
Reason: Lost to follow-up Reason: Lost to follow-up

Figure 1: CONSORT flow diagram

undergoing self‑care education) and control group (mothers for pregnancy and their relationships with preterm birth.
at risk of preterm birth undergoing common prenatal care Participants were given two HPCASs to complete before
during pregnancy). In the next step, the personal and the second and third sessions of the training based on their
midwifery characteristics questionnaire and HPCAS were self‑care behaviors during the last week and hand it over to
completed by them. Educational needs of the intervention the researcher. At the end of the third session, the general
group were evaluated based on the HPCAS, and then the content of education was given to them as pamphlets. The
necessary training was provided in three 45–60‑minute control group received only the usual prenatal care by
sessions in 3 consecutive weeks individually and the midwife of the health center. The control group also
face‑to‑face. After the training, training cards were given completed HPCAS for 2 consecutive weeks and delivered
to the subjects in the intervention group based on each it to the researcher. Until the 40th week, the researcher
individual’s needs. Educational content was designed based contacted the intervention and control groups via telephone
on the Orem’s self‑care theory. It contained universal to inform them about the process of pregnancy, delivery,
self‑care requisites including adequate nutrition, fluid or lack of delivery. The researcher’s phone number was
intake, drinking milk, avoidance of drinking coffee and given to all participants and all (those in intervention and
alcohol, healthy air intake, avoidance of smoking, balance control groups) were requested to contact the researcher
between activity and rest, enough sleeping, physical risk if they went to the hospital and were hospitalized for
prevention, avoiding of stress, anxiety and depression, delivery. The researcher then asked the participants in the
social support and relationships of pregnant women at postpartum period to come to health centers and again
risk for preterm labor. Also it contained developmental complete HPCAS. Finally, the educational content was also
self‑care requisites including regular visits to health centers provided to the control group. Data analysis were done
or physicians for prenatal care, proper weight gain in using statistical software (version 18 SPSS Inc, Chicago,
pregnancy, intake of prescribed prenatal vitamins and iron IL, USA). In order to investigate the homogeneity of the
tablets; and health deviation self‑care requisites including two groups, Chi‑square and exact Chi‑square tests were
bleeding in pregnancy, premature uterine contractions, used. The independent samples t‑test and Mann‑Whitney
pyelonephritis, periodontitis, bacterial vaginosis, U test were used to compare the intervention and control
preeclampsia, oligohydramnios, polyhydramnios, diabetes, groups in terms of length of pregnancy. Chi‑square was
placenta previa, anatomic abnormality of uterus and history used to estimate the effect of prenatal self‑care on preterm
of organic disorder (cardiac, renal, thyroid), risk factors birth occurrence. Statistical significance was set at p ≤ 0.05.

244 Iranian Journal of Nursing and Midwifery Research ¦ Volume 25 ¦ Issue 3 ¦ May-June 2020
 Rezaeean, et al.: Effect of prenatal self‑care on preterm birth

Ethical considerations difference between two groups in terms of the history

of self‑care education in pregnancy, self‑care education
The present research was conducted after gaining approval
resources, information on preterm birth and self‑care
by the research deputy as well as the Ethics Committee of
activities, and interest in learning about complications
Mashhad University of Medical Sciences, Mashhad, Iran
of preterm birth (p > 0.05). But, there were significant
and obtaining a letter of recommendation from the Faculty
differences between the two groups in terms of interest
of Nursing and Midwifery of Mashhad and presenting it to
in learning about symptoms of preterm birth and self‑care
the authorities of health centers. The approved code of the
activities (χ2 = 9.94, df = 2, p < 0.05). Therefore,
ethics committee was IR.MUMS.REC.1394.448.
comparisons between the intervention and control groups
Results in terms of interest in learning about symptoms of preterm
birth and self‑care activities were carried out using
The mean (SD) age of participants was 28.61 (6.21) analysis of covariance. The results showed that removing
years in the intervention group and 28.38 (6.62) years in these variables does not change the outcome of the study,
the control group, but there was no significant difference and yet significant differences existed between the two
between the two groups (p = 0.861). With regard to the groups (p < 0.001). There was no statistically significant
education level, 38 (43.20%) women in the intervention difference between the two groups in terms of self‑care
group and 39 (44.30%) in the control group had a during pregnancy before the intervention (p = 0.899).
high school diploma and the difference between the
two groups was not statistically significant (p = 0.68). Based on the independent samples t‑test, the length of
Furthermore, most of the subjects in the intervention pregnancy was significantly different between the two
62 (70.50%) and control group 61 (69.30%) had sufficient groups (t174 = 2.18, p = 0.03). In other words, the duration
income (p = 1.00). The mean age, husband’s age and length of pregnancy was significantly longer in the intervention
of marriage based on results of the independent t‑test, group [Table 2].
and the frequency of husband’s education, occupation, According to Chi‑square test, there was a significant
husband’s job, family income, insurance, insurance type, difference between two groups in the prevalence of preterm
and housing status based on results of the Chi‑square birth (χ2 = 6.94, df = 1, p = 0.008); six cases (6.80%) in
test were not significantly different in between the two the intervention group and 18 cases (20.50%) in the control
groups (p > 0.05). There was no statistically significant group had a preterm birth. Furthermore, 82 (93.20%)
difference between the two groups in term of number of women in the intervention group and 70 (79.50%) in
pregnancies, number of deliveries, number of abortions, the control group didn’t have preterm birth [Table 3].
number of preterm deliveries, number of live children, Also, based on the results of multiple linear regression
number of dead children, number of stillbirths, and interval test to investigate the role of demographic and obstetric
of current and previous pregnancy (p > 0.05) [Table 1]. characteristics (age of mothers, education, income, job,
Most of the participants in the intervention 57 (64.80%) husbands job, housing status, insurance type, number of
and control 50 (56.80%) groups had no history of pregnancies, number of deliveries, number of abortions,
self‑care education in pregnancy (p = 0.28). Also, most number of preterm births, number of alive children, number
of the participants (59 [67.00%]) in the intervention of dead children, number of stillbirths, interval of current
and 57 (64.80%) control groups had little information and previous pregnancy, history of self‑care education,
about preterm birth and self‑care activities during interest in learning about complications of preterm birth,
pregnancy (p = 0.596). There was no significant interest in learning about symptoms of preterm birth,

Table 1: Comparison of mean scores midwifery characteristics between two groups

Intervention group mean (SD) Control group mean (SD) t df p
Number of pregnancies 2.60 (1.67) 2.48 (1.41) 0.39 174 0.93
Number of deliveries 1.00 (1.13) 0.86 (0.88) 0.51 174 0.98
Number of abortions 0.60 (0.97) 0.59 (0.90) 0.00 174 0.89
Number of preterm labor 0.21 (0.49) 0.28 (0.47) ‑1.05 174 0.20
Number of live children 0.75 (0.93) 0.70 (0.82) 0.65 174 0.77
Number of dead children 0.07 (0.31) 0.15 (0.45) ‑0.76 174 0.47
Number of stillbirths 0.05 (0.23) 0.02 (0.14) 1.15 174 0.24
Interval of current and previous pregnancy (year) 5.25 (3.91) 3.95 (4.40) 0.40 119 0.61

Table 2: Comparison of mean scores of length of pregnancy between two groups

Intervention group mean (SD) Control group mean (SD) t df p
Duration of pregnancy (week) 38.97 (1.45) 38.27 (2.61) 2.18 174 0.030

Iranian Journal of Nursing and Midwifery Research ¦ Volume 25 ¦ Issue 3 ¦ May-June 2020 245
 Rezaeean, et al.: Effect of prenatal self‑care on preterm birth

and self‑care activities) on the effect of prenatal self‑care prevention during the pregnancy.[27] Results of research by
education based on Orem’s theory on preterm birth Bostani‑Khales et al. (2013) with the aim of studying “the
occurrence, none of them had significant linear regression relationship between prenatal care utilization index and
with preterm birth (p > 0.05) [Table 4]. neonatal outcomes” on 205 pregnant women referring to
health care centers of Rasht, Iran indicated that the greater
Discussion prenatal care and subsequently educating pregnant mothers
The results of the study showed that using self‑care to decrease the incidence of preterm labor.[30] Kamalifard
education based on Orem’s theory leads to the increased et al. (2010) investigated the effect of lifestyle on the rate
length of pregnancy and proximity of delivery to the of preterm birth in 132 women with a history of preterm
term and in fact, reduced incidence of preterm birth. In labor and 264 women without any history of preterm labor.
other words, the incidence of preterm birth in the control They studied the lifestyle variables including nutrition,
group was approximately three times higher than that in smoking, consumption of alcohol and invalid drugs, social
the intervention group. In terms of the effect of self‑care relationships, stress, and self‑care and concluded that
on the preterm birth, results of the present study were women with term delivery had a better lifestyle than those
consistent with studies by Rajaeefard et al.,[27] Avelyn,[12] with preterm labor.[10] Finally, Avelyn (2012) investigated
Kamalifard et al.,[10] and Bostani‑Khalesi et al.[30] the relationship between prenatal self‑care practices during
Rajaeifard et al. (2010) conducted a study to determine pregnancy and birth outcomes among 80 young mothers
the risk factors of preterm delivery and the effects of aged 16–24 at Gweru maternity hospital of Zimbabwe and
education on its prevention on 1,117 pregnant women with found that self‑care during the pregnancy based on Orem’s
less than 37 weeks of pregnancy referring to maternal and theory increases the duration of pregnancy and reduces the
child health units in 36 health centers of Shiraz, Iran. They
preterm labor.[12]
could reduce the incidence of preterm labor by identifying
pregnant women at risk for preterm labor through According to Orem’s educational support system, when
Holbrook’s preterm delivery screening and teaching them a patient has the capacity but needs help for learning or
the importance, symptoms, and principles of preterm labor doing things, decision‑making, selecting methods, and

Table 3: Frequency of preterm birth incidence in two groups

Intervention group n (%) Control group n (%) Total n (%) χ2 Chi‑square df p
Preterm birth
Yes 6 (6.80%) 18 (20.50%) 24 (13.60%) 6.94 1 0.008
No 82 (93.20%) 70 (79.50%) 152 (86.40%)
Total 88 (100.00%) 88 (100.00%) 176 (100.00%)

Table 4: Role of demographic and obstetric characteristics on the effect of prenatal self‑care based on Orem’s theory
on preterm birth occurrence in women at risk for preterm birth
Beta Std. Error Linear regression t p
Constant 2.90 490 5.93 <0.001
Age of mothers −0.01 0.00 −1.46 0.14
Education −0.02 0.03 −0.72 0.47
Income 0.04 0.08 −0.58 0.55
Job 0.06 0.06 0.99 0.32
Husbands job 0.00 0.04 0.00 0.99
Insurance type −0.31 0.16 −1.87 0.06
Housing status −0.01 0.02 −0.48 0.62
Number of pregnancies −0.07 0.37 −0.19 0.84
Number of deliveries −0.19 0.43 −0.44 0.66
Number of abortions 0.09 0.37 0.24 0.80
Number of preterm labor −0.04 0.07 −0.61 0.54
Number of alive children 0.34 0.57 0.59 0.55
Number of dead children 0.31 0.56 0.56 0.57
Number of stillbirths 0.38 0.54 0.71 0.47
Interval of current and previous pregnancy (Year) −0.02 0.05 −0.74 0.38
History of self‑care education −0.08 0.06 −1.31 0.19
Interest in learning about complications of preterm birth 0.06 0.07 0.80 0.42
Interest in learning about symptoms of preterm birth and self‑care activities −0.09 0.07 −1.23 0.22

246 Iranian Journal of Nursing and Midwifery Research ¦ Volume 25 ¦ Issue 3 ¦ May-June 2020
 Rezaeean, et al.: Effect of prenatal self‑care on preterm birth

using specific knowledge or skills, nurses take on the during pregnancy to reduce the incidence of preterm
role of counselor to help the patients do the self‑care birth. Also, according to the first HPCAS, the educational
activities.[16] Therefore, the researcher, as a counselor, needs of each mother were evaluated and the researcher
taught self‑care activities during pregnancy and emphasized their needs and in the following weeks, based
dependent‑care activities (fetus) to pregnant mothers at risk on how to respond in this questionnaire, the researcher
for preterm birth based on mother’s self‑care requisites and determined whether the training had been able to meet the
the dependent‑care requisites (fetus). According to Orem’s mother’s need. In this study, mothers were taught how each
assumptions, humans have the power to think, reason, and of the factors affecting the incidence of preterm labor can
take responsibility, and they can take care of themselves lead to preterm birth. Finally, mothers gained the awareness
and have acceptable performance. As a result, mothers that how they can take care of themselves in order to
at risk for preterm birth considered themselves self‑care prevent preterm birth. The present study faced limitations
agents and dependent‑care agents for their fetus to promote such as ignoring the individual differences and mental
self‑care behaviors[31] and improve pregnancy outcomes for status of the participants. Not being able to closely monitor
their fetuses (increase the length of pregnancy and reduce on self‑care activities and to use HPCAS as a self‑report
the incidence of preterm birth and its complications) after that was trusted to the research units’ responses. Some of
becoming aware of self‑care behavior and dependent‑care the factors affecting preterm birth, including racial‑ethnic
activities (fetus) associated with preterm birth. Finally, it differences and genetic factors, were out of the control of
led to an increase in the length of pregnancy and a decrease the researcher.
in the incidence of preterm birth in the intervention group
compared to the control group. Conclusion
However, the results of the present study were inconsistent Given the effect of prenatal self‑care based on Orem’s
with the results of a study by Lotfalizadeh et al. (2005) theory on preterm birth occurrence in women at risk for
on the effect of self‑care on the duration of pregnancy and preterm birth, it is suggested pregnant women at risk
preterm birth. They conducted a cross‑sectional study to for preterm birth are identified and provided with them
measure the prevalence and risk factors of preterm labor self‑care education in health care centers in order to
in 600 participants (300 with preterm deliveries and 300 increase the length of pregnancy and reduce the incidence
with term deliveries) at Imam Reza Hospital, Mashhad, of preterm birth.
Iran. Results of their study showed that smoking, maternal Acknowledgments
medical status, and type of prenatal care are significantly
related to preterm labor.[28] Tobacco use is a variable of The present paper was extracted from a master thesis in
Orem’s universal self‑care requisites during pregnancy; the Midwifery in Mashhad University of Medical Sciences,
prenatal care method is a variable of Orem’s developmental Mashhad, Iran with the identification number of 940364.
self‑care requisites during pregnancy, and the maternal We are deeply grateful to the research deputy of Mashhad
medical status is a variable of Orem’s health deviation University of Medical Sciences for sponsoring the project.
self‑care requisites in the pregnancy. According to We also thank the authorities of healthcare centers affiliated
Lotfalizadeh, none of the above variables were associated to Mashhad University of Medical Sciences and all the
with the preterm labor, and thus their research was participants for their cooperation.
inconsistent with the present study. The reason for different Financial support and sponsorship
effects of prenatal care on the length of pregnancy and the
incidence of preterm labor could be due to differences in Mashhad University of Medical Sciences, Mashhad, Iran
types of data collection instruments, design of the study, Conflicts of interest
and their implementation methods between studies. In a
study by Lotfalizadeh, type of pregnancy care measured Nothing to declare.
based on interview and patient records did not show any
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248 Iranian Journal of Nursing and Midwifery Research ¦ Volume 25 ¦ Issue 3 ¦ May-June 2020