Effect of Antenatal Education on Fear of Childbirth, Mental Health, and Perceived Stress in Primiparous Pregnant Women: A Prospective Randomized Controlled Trial

Effect of Antenatal Education on Fear of Childbirth, Mental Health, and Perceived Stress in Primiparous Pregnant Women: A Prospective Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Antenatal Education on Fear of Childbirth, Mental Health, and Perceived Stress in Primiparous Pregnant Women: A Prospective Randomized Controlled Trial Leyla KAYA, Yıldız BİLGE, Esra KELES, Umut ERKOK, Zahide KAYA This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7041181/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Dec, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 10 You are reading this latest preprint version Abstract Background This study aimed to investigate the the impact of antenatal education on fear of childbirth, mental well-being, and perceived stress in primiparous pregnant women. Methods This study was a prospective, randomized controlled trial conducted on primiparous women with a score of 85 or above on the Wijma Delivery Expectancy/ Experience Questionnaire (W-DEQ) between October 2022 and October 2023. The pregnant women were randomized to either the antenatal education group (n = 50) or the control group (n = 50). The antenatal education group received a 6-week antenatal education program consisting of 90-minute session each week. Both groups were compared for fear of childbirth, perceived stress, and mental well-being before starting the education, after the education (between 20–36 weeks), and 6–8 weeks postpartum. The study followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Results It was found that the antenatal education group experienced less fear of childbirth, improved mental health, and decreased perceived stress compared to the control group (p < 0.0001). Conclusion Antenatal education may be beneficial in alleviating the fear of childbirth, improving mental health, and reducing stress symptoms during and after childbirth. Therefore, it may be worth considering routine implementation of antenatal education as a standard component of prenatal care. Trial and protocol registration Clinical Trials; ID: NCT05584618; Date: 13.10.2022; URL: https://clinicaltrials.gov/study/NCT05584618 Antenatal education fear of childbirth stress mental health pregnancy Figures Figure 1 Figure 2 Introduction Antenatal education plays a critical role in promoting health and well-being of both expectant mothers and their infants. It is designed to educate and empower expectant mothers, providing with the necessary knowledge and skills to better cope with the childbirth process[ 1 ]. It aims to enhance the overall childbirth experience and ease birth pain, while also prepares mothers for postnatal care, breastfeeding, and parenting [ 2 ]. These programs offer more contact time with midwives and provide exceptional opportunities to improve knowledge, skills, build confidence and develop relationships with other expectant parents and maternity care providers [ 3 ]. In all, antenatal education helps to identify and prevent complications for both the mother and baby, which significantly result in reduced perinatal morbidity and mortality [ 4 ]. Research has yielded inconsistent results about the effectiveness of antenatal education on birth-related fear, and maternal mental well-being. For instance, Fabian et al. [ 5 ] observed limited effects, whereas Aba and Kömürcü [ 6 ] found no significant difference between groups that received antenatal education versus those that did not. On the other hand, Çankaya et al. [ 7 ] found a significant difference favoring the antenatal education group. Therefore, we aimed to examine the impact of antenatal education on fear of birth, mental well-being, and perceived stres in primiparous pregnant women. Such studies could provide a better understanding of the effects of antenatal education and help refine its delivery to ensure optimal outcomes for both mother and child. Methods Study design This two-arm parallel, single-blind, randomized trial was carried out on primigravid women who presented at the antenatal outpatient polyclinic, had a Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) score of 85 or above, and underwent vaginal delivery, between October 2022 and October 2023. The study comprised two groups, antenatal education and control groups. The study administered scales to both groups at three different time points, which were before the start of education, after the education (between 20–36 weeks), and 6–8 weeks postpartum. The Consolidated Standards of Reporting Trials (CONSORT) guidelines were followed. Sample size Sample size of the study was determined using the G Power 3.1 based on established literature[ 7 ]. A 90% statistical power (1-β) was considered at the 0.05 (α) significance level, and the two-way ANOVA was used for medium effect size. The required sample size was computed to be 50 subjects. Randomization In this study, pregnant women were randomly assigned to either the antenatal education or control group based on their order of arrival, using the random number generation method. Study participants The study included pregnant women who were between 26–28 weeks of gestation, had at least a primary school education, were nulliparous, did not have a high-risk pregnancy, did not have any diseases, did not experience postpartum complications, and did not participate in any other antenatal program during the prenatal period. Furthermore, the women gave birth to healthy newborns between 38 and 42 weeks of gestation, and the newborns were not low birth weight. Intervention A six-week antenatal education program consisting of 90-minute sessions each week was implemented. The curriculum covered a wide range of topics related to pregnancy and early motherhood, such as fetomaternal physiology, physiological adaptations to pregnancy, pregnancy complications and risk management, nutritional optimization for pregnant women, safe and effective exercise during pregnancy, birth preparation, pain management, breathing exercises, postpartum care, breastfeeding support, neonatal care, and family planning. Measures The sociodemographic data form created by the researchers included questions about age, education level, marital status, occupation, and history of psychiatric illness. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is a tool developed by Wijma et al. to assess the level of fear women feel concerning childbirth [ 8 ]. The Turkish adaptation of this scale was carried out by Korukcu and colleagues [ 9 ]. It consists of 33 items scored using a 6-point Likert scale, with values ranging from 0 to 5. The overall score can vary from 0 to 165, where higher totals indicate greater levels of fear associated with childbirth among women. The W-DEQ categorizes fear of childbirth into four categories: low ( 85). Our research revealed that the scale demonstrated high internal consistency, achieving a Cronbach's alpha coefficient of .96. Perceived Stress Scale (PSS) is a 14-item scale with two sub-dimensions: Perception of Inadequate Self-Efficacy and Perception of Stress/Discomfort [ 10 ]. It is a 5-point Likert-type scale and aids in evaluating how individuals interpret different situations in their lives as stressful. The Turkish adaptation of the scale has demonstrated a high level of internal consistency, achieving a coefficient of 0.84, and has a test-retest reliability of 0.87. Research has shown that the scale possesses acceptable internal consistency, as indicated by a Cronbach's alpha coefficient of 0.77. Multidimensional Scale of Perceived Social Support (MSPSS) is an assessment tool designed to measure social support from family, friends, and a significant other with high internal consistency (Cronbach's alpha of 0.92) [ 11 , 12 ]. Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is a 14-item 5-point Likert-type scale that measures psychological well-being, originally developed by Tennant et al.[ 13 ], and later adapted for use in Turkish by Keldal [ 14 ]. The scale assesses psychological well-being with higher scores denoting elevated levels of psychological well-being. The scale demonstrates strong internal consistency with a Cronbach's alpha of 0.89. Statistical analysis The skewness and kurtosis values of the continuous variables of the study were within the range of + 1.5–1.5, indicating a normal distribution according to the criteria of George and Mallery (2016). The comparison of pretest scores between the groups was done with an independent samples t-test. The scores of the groups were differentiated based on the repeated measurements (pretest, prenatal, and 6–8 weeks after birth) using repeated measures two-way analysis of variance ANOVA (3 X 2). The data analysis was performed using the SPSS 25 program. Results The study initially evaluated 196 women for eligibility, out of which 60 were excluded for not fulfilling the inclusion criteria, and 20 declined to participate. This led to a total of 112 pregnant women participating in the study. However, during the course of the study, six participants from antenatal education discontinued training, two women from the control group delivered prematurely, and four women were excluded due to discontinuation from antenatal education. Finally, the study concluded with 50 participants in both the antenatal and control groups (Fig. 1 ). There were no significant differences in demographic characteristics between groups (Table 1 ). The study compared pre-tests conducted on pregnant women with a score of 85 and above on the W-DEQ, PSS, MSPSS and WEMWBS scores before and after the antenatal education program using an independent samples t-test. No significant difference was observed between the groups in all variables (Table 2 ). Table 1 Demographic characteristics of the participants in the antenatal education and control groups. Variables Antenatal Education Group (n = 50) Control Group (n = 50) n % n % Age (year) 18–25 8 16 42 84 26–35 42 84 8 16 Education Secondary School 0 0 13 26 High School 3 6 14 28 University and above 47 94 23 46 Family income Low 0 0 10 20 Medium 50 100 40 80 High 0 0 0 0 Employment Housewife 12 24 30 60 Civil servant 30 60 7 14 Private sector 8 16 13 26 Table 2 Comparison of Groups in Terms of W-DEQ, PSS, MSPSS, andWEMWBS scores Antenatal Education Group (n = 50) Control Group (n = 50) t p M SD M SD W-DEQ 50.42 7.03 50.30 8.42 .077 .938 PSS 18.90 6.22 17.24 7.49 1.21 .231 MSPSS 56.14 11.43 57.86 10.15 − .79 .428 WEMWBS 106.86 10.77 103.62 9.69 1.58 .117 W-DEQ: Wijma Delivery Expectancy/ExperienceQuestionnaire, PSS: Perceived StressScale, MSPSS: MultidimensionalScale of PerceivedSocialSupport, WEMWBS: Warwick-Edinburgh MentalWell-BeingScale , The analysis of perceived stress revealed significant effects for the measurements made [F(1.79, 98.21) = 23.13, P < 0.0001] and the joint effects of the repeated measurements in the antenatal education and control groups [F(1.79, 98.21) = 43.75, P < 0.0001]. Mauchly's test of sphericity (p < 0.001) was rejected, so repeated ANOVA with Greenhouse-Geisser correction was used. These results favor the antenatal education group. In the analysis of perceived social support, the null hypothesis of sphericity was rejected based on Mauchly's test (p < 0.001). Based on the results of repeated ANOVA with Greenhouse-Geisser correction, the measurements for perceived social support had a significant effect [F (1.61,98.39) = 9.56, P < 0.0001]. Additionally, the joint effects of repeated measurements (pretest, prenatal test, postnatal test) made in the antenatal education and control groups on perceived social support were significant [F (1.61,98.39) = 13.42, P < 0.0001]. The antenatal education group scored significantly higher than the control group. The repeated ANOVA with Greenhouse-Geisser correction indicated that the effects of the measures for mental well-being [F (1.82, 98.18) = 8.02, P < 0.001] and the joint effects of repeated measures on mental well-being in the antenatal education and control groups [F (1.82, 98.18) = 26.62, P < 0.0001] were significant in favor of the antenatal education group, as Mauchly's test of sphericity was rejected (p < 0.001) during the analysis (Table 3 , Fig. 2 ). Table 3 Participants' repeated-measures two-way ANOVA results Source of Variance Sum of Squares df MeanSquare F p ŋ 2 W-DEQ Measurement 35552.75 1.65 21517.18 170.44 .000 .635 Measurement*Group 43873.95 1.65 26553.32 210.33 .000 .682 Error (Measurement) 20441.97 161.93 126.24 PSS Measurement 1442.22 1.79 804.29 23.13 .000 .191 Measurement*Group 2727.89 1.79 1521.28 43.75 .000 .309 Error (Measurement) 6110.56 175.73 34.77 MSPSS Measurement 858.91 1.61 533.30 9.56 .000 .089 Measurement*Group 1206.75 1.61 749.27 13.42 .000 .120 Error (Measurement) 8809.68 157.84 55.82 WEMWBS Measurement 538.25 1.82 295.54 8.02 .001 .076 Measurement*Group 1785.86 1.82 980.58 26.62 .000 .214 Error (Measurement) 6573.89 178.48 36.83 W-DEQ: Wijma Delivery Expectancy/ExperienceQuestionnaire, PSS: PerceivedStressScale, MSPSS: MultidimensionalScale of PerceivedSocialSupport, WEMWBS: Warwick-Edinburgh MentalWell-BeingScale , Discussion This research indicated that antenatal education reduced fear of childbirth, improved mental health, and decreased perceived stress levels both during pregnancy and postpartum. It can be suggested that antenatal education may play a significant role in reducing the fear of birth in primiparous pregnant women. Several experimental studies have also validated the efficacy of antenatal training courses in reducing women's fear of childbirth [ 15 , 16 ]. Furthermore, a recent study found that women who received antenatal education scored significantly lower on childbirth fear than those who did not [ 17 ]. It has been published in the scientific literature that fear of birth can stem from misinformation, negative perceptions, and biases [ 18 ]. Antenatal education can effectively mitigate these fears by providing women with accurate information about childbirth, correcting misconceptions, and promoting positive perceptions. This study provides support for the idea that antenatal education can reduce stress symptoms and improve mental health in primiparous pregnant women during pre-and postnatal periods. According to recent research, attending antenatal education can have a positive impact on the mental health of pregnant and postpartum women [ 19 , 20 ]. Research has shown that participating in training courses may reduce anxiety symptoms, while information received during pregnancy can minimize birth-related stress [ 21 , 22 ]. Expectant first-time mothers who undergo psychological preparation for childbirth have also reported lower levels of anxiety and depression [ 23 ]. Furthermore, an 8-week childbirth education program has been shown to decrease depression scores and promote lower anxiety and stress levels during the postpartum period [ 24 , 25 ]. Another study conducted in Turkey supports these findings, indicating that antenatal education can lead to reduced symptoms of depression, anxiety, and stress both during and after pregnancy [ 7 ]. Limitations The study has certain limitations that should be taken into account. It was conducted in a single hospital and focused on primiparous pregnant women with a severe fear of childbirth. As a result, the generalizability of the findings may be limited. Notwithstanding these constraints, there are some notable strengths to our study. It was a single-blind randomized controlled trial, revealing that antenatal education may be effective and feasible. Moreover, our study delved into the social support and psychological status of women, which is a significant difference from previous research. Overall, our findings provides valuable insights into the efficacy of antenatal education in enhancing the psychological well-being of pregnant women. Conclusion Antenatal education may be beneficial in alleviating the fear of childbirth, improving mental health, and reducing stress symptoms during and after childbirth. Therefore, it may be worth considering routine implementation of antenatal education as a standard component of prenatal care. Abbreviations Wijma Delivery Expectancy/ Experience Questionnaire (W-DEQ) Perceived Social Support (MSPSS) Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) Declarations Acknowledgements The authors extend their sincere gratitude to all the women who willingly participated in this study. Author contributions LK: Conceptualization, Data Curation, Writing – Original Draft, Writing – Review & Editing. YB: Formal Analysis, Writing – Original Draft, Writing – Review & Editing. EK: Conceptualization, Formal analysis, Writing – Original Draft, Writing –Review & Editing. UE: Conceptualization, Writing – Original Draft, Writing – Review & Editing. ZK: Data Curation, Writing – Original Draft, Writing – Review & Editing. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The database was managed in accordance with applicable privacy legislation, and the study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The study was approved by the Ethics Committee of the University of Health Sciences, Zeynep Kamil Women and Children’s Diseases Training and Research Hospital (Approval number: 73; Date: 08.06.2022). Written and verbal informed consent was obtained from all participants prior to inclusion in the study. The trial is registered on ClinicalTrials.gov (Ref. No: NCT05584618). Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Spiby H, Stewart J, Watts K, Hughes AJ, Slade P. The importance of face to face, group antenatal education classes for first time mothers: A qualitative study. Midwifery. 2022;109:103295. Alizadeh-Dibazari Z, Abdolalipour S, Mirghafourvand M. The effect of prenatal education on fear of childbirth, pain intensity during labour and childbirth experience: a scoping review using systematic approach and meta-analysis. BMC Pregnancy Childbirth. 2023;23(1):541. AlSomali Z, Bajamal E, Esheaba O, AlSomali ZA. The effect of structured antenatal education on childbirth self-efficacy. Cureus. 2023;15(5):e39285. AlDughaishi MYK, Seshan V, Matua GA. Antenatal education services in oman: a descriptive qualitative inquiry of healthcare provider's perspective. SAGE Open Nurs. 2023;9:23779608231167820. Fabian HM, Radestad IJ, Waldeström U. Childbirth and parenthood education classes in Sweden. Women’s opinion and possible outcomes. Acta Obstet Gynecol Scand. 2005;84:436–43. Aba YA, Kömürcü N. Antenatal education on pregnant adolescents in Turkey: prenatal adaptation, postpartum adaptation, and newborn perceptions. Asian Nurs Res. 2017;11(1):42-9. Çankaya S, Şimşek B. 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Kuo TC, Au HK, Chen SR, Chipojola R, Lee GT, Lee PH, et al. Effects of an integrated childbirth education program to reduce fear of childbirth, anxiety, and depression, and improve dispositional mindfulness: A single-blind randomised controlled trial. Midwifery. 2022;113:103438. Additional Declarations No competing interests reported. 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10:51:35","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":31756,"visible":true,"origin":"","legend":"","description":"","filename":"CONSORT2025editablechecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-7041181/v1/689d7fc59178bb5f8aa8ccfa.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Antenatal Education on Fear of Childbirth, Mental Health, and Perceived Stress in Primiparous Pregnant Women: A Prospective Randomized Controlled Trial","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAntenatal education plays a critical role in promoting health and well-being of both expectant mothers and their infants. It is designed to educate and empower expectant mothers, providing with the necessary knowledge and skills to better cope with the childbirth process[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It aims to enhance the overall childbirth experience and ease birth pain, while also prepares mothers for postnatal care, breastfeeding, and parenting [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These programs offer more contact time with midwives and provide exceptional opportunities to improve knowledge, skills, build confidence and develop relationships with other expectant parents and maternity care providers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In all, antenatal education helps to identify and prevent complications for both the mother and baby, which significantly result in reduced perinatal morbidity and mortality [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResearch has yielded inconsistent results about the effectiveness of antenatal education on birth-related fear, and maternal mental well-being. For instance, Fabian et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] observed limited effects, whereas Aba and Kömürcü [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] found no significant difference between groups that received antenatal education versus those that did not. On the other hand, Çankaya et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] found a significant difference favoring the antenatal education group. Therefore, we aimed to examine the impact of antenatal education on fear of birth, mental well-being, and perceived stres in primiparous pregnant women. Such studies could provide a better understanding of the effects of antenatal education and help refine its delivery to ensure optimal outcomes for both mother and child.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis two-arm parallel, single-blind, randomized trial was carried out on primigravid women who presented at the antenatal outpatient polyclinic, had a Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) score of 85 or above, and underwent vaginal delivery, between October 2022 and October 2023. The study comprised two groups, antenatal education and control groups. The study administered scales to both groups at three different time points, which were before the start of education, after the education (between 20–36 weeks), and 6–8 weeks postpartum. The Consolidated Standards of Reporting Trials (CONSORT) guidelines were followed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSample size of the study was determined using the G Power 3.1 based on established literature[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A 90% statistical power (1-β) was considered at the 0.05 (α) significance level, and the two-way ANOVA was used for medium effect size. The required sample size was computed to be 50 subjects.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRandomization\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn this study, pregnant women were randomly assigned to either the antenatal education or control group based on their order of arrival, using the random number generation method.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy participants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study included pregnant women who were between 26–28 weeks of gestation, had at least a primary school education, were nulliparous, did not have a high-risk pregnancy, did not have any diseases, did not experience postpartum complications, and did not participate in any other antenatal program during the prenatal period. Furthermore, the women gave birth to healthy newborns between 38 and 42 weeks of gestation, and the newborns were not low birth weight.\u003c/p\u003e\u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA six-week antenatal education program consisting of 90-minute sessions each week was implemented. The curriculum covered a wide range of topics related to pregnancy and early motherhood, such as fetomaternal physiology, physiological adaptations to pregnancy, pregnancy complications and risk management, nutritional optimization for pregnant women, safe and effective exercise during pregnancy, birth preparation, pain management, breathing exercises, postpartum care, breastfeeding support, neonatal care, and family planning.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sociodemographic data form created by the researchers included questions about age, education level, marital status, occupation, and history of psychiatric illness.\u003c/p\u003e\u003cp\u003eThe Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is a tool developed by Wijma et al. to assess the level of fear women feel concerning childbirth [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The Turkish adaptation of this scale was carried out by Korukcu and colleagues [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It consists of 33 items scored using a 6-point Likert scale, with values ranging from 0 to 5. The overall score can vary from 0 to 165, where higher totals indicate greater levels of fear associated with childbirth among women. The W-DEQ categorizes fear of childbirth into four categories: low (\u0026lt; 37), moderate (38–65), high (66–84), and severe (\u0026gt; 85). Our research revealed that the scale demonstrated high internal consistency, achieving a Cronbach's alpha coefficient of .96.\u003c/p\u003e\u003cp\u003ePerceived Stress Scale (PSS) is a 14-item scale with two sub-dimensions: Perception of Inadequate Self-Efficacy and Perception of Stress/Discomfort [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It is a 5-point Likert-type scale and aids in evaluating how individuals interpret different situations in their lives as stressful. The Turkish adaptation of the scale has demonstrated a high level of internal consistency, achieving a coefficient of 0.84, and has a test-retest reliability of 0.87. Research has shown that the scale possesses acceptable internal consistency, as indicated by a Cronbach's alpha coefficient of 0.77.\u003c/p\u003e\u003cp\u003eMultidimensional Scale of Perceived Social Support (MSPSS) is an assessment tool designed to measure social support from family, friends, and a significant other with high internal consistency (Cronbach's alpha of 0.92) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWarwick-Edinburgh Mental Well-Being Scale (WEMWBS) is a 14-item 5-point Likert-type scale that measures psychological well-being, originally developed by Tennant et al.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and later adapted for use in Turkish by Keldal [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The scale assesses psychological well-being with higher scores denoting elevated levels of psychological well-being. The scale demonstrates strong internal consistency with a Cronbach's alpha of 0.89.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe skewness and kurtosis values of the continuous variables of the study were within the range of + 1.5–1.5, indicating a normal distribution according to the criteria of George and Mallery (2016).\u003c/p\u003e\u003cp\u003eThe comparison of pretest scores between the groups was done with an independent samples t-test. The scores of the groups were differentiated based on the repeated measurements (pretest, prenatal, and 6–8 weeks after birth) using repeated measures two-way analysis of variance ANOVA (3 X 2). The data analysis was performed using the SPSS 25 program.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study initially evaluated 196 women for eligibility, out of which 60 were excluded for not fulfilling the inclusion criteria, and 20 declined to participate. This led to a total of 112 pregnant women participating in the study. However, during the course of the study, six participants from antenatal education discontinued training, two women from the control group delivered prematurely, and four women were excluded due to discontinuation from antenatal education. Finally, the study concluded with 50 participants in both the antenatal and control groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThere were no significant differences in demographic characteristics between groups (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The study compared pre-tests conducted on pregnant women with a score of 85 and above on the W-DEQ, PSS, MSPSS and WEMWBS scores before and after the antenatal education program using an independent samples t-test. No significant difference was observed between the groups in all variables (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of the participants in the antenatal education and control groups.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAntenatal Education Group (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldItalicUnderline\" class=\"BoldItalicUnderline\" name=\"Emphasis\"\u003eAge (year)\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldItalicUnderline\" class=\"BoldItalicUnderline\" name=\"Emphasis\"\u003eEducation\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldItalicUnderline\" class=\"BoldItalicUnderline\" name=\"Emphasis\"\u003eFamily income\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedium\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cspan type=\"BoldItalicUnderline\" class=\"BoldItalicUnderline\" name=\"Emphasis\"\u003eEmployment\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousewife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCivil servant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrivate sector\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Groups in Terms of W-DEQ, PSS, MSPSS, andWEMWBS scores\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eAntenatal Education Group (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eControl Group (n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eW-DEQ\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e8.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.077\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.938\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePSS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.231\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMSPSS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e56.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e10.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.428\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eWEMWBS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e106.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e103.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e9.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eW-DEQ: Wijma Delivery Expectancy/ExperienceQuestionnaire, PSS: Perceived StressScale, MSPSS: MultidimensionalScale of PerceivedSocialSupport, WEMWBS: Warwick-Edinburgh MentalWell-BeingScale\u003c/em\u003e,\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe analysis of perceived stress revealed significant effects for the measurements made [F(1.79, 98.21)\u0026thinsp;=\u0026thinsp;23.13, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001] and the joint effects of the repeated measurements in the antenatal education and control groups [F(1.79, 98.21)\u0026thinsp;=\u0026thinsp;43.75, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001]. Mauchly's test of sphericity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was rejected, so repeated ANOVA with Greenhouse-Geisser correction was used. These results favor the antenatal education group. In the analysis of perceived social support, the null hypothesis of sphericity was rejected based on Mauchly's test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Based on the results of repeated ANOVA with Greenhouse-Geisser correction, the measurements for perceived social support had a significant effect [F (1.61,98.39)\u0026thinsp;=\u0026thinsp;9.56, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001]. Additionally, the joint effects of repeated measurements (pretest, prenatal test, postnatal test) made in the antenatal education and control groups on perceived social support were significant [F (1.61,98.39)\u0026thinsp;=\u0026thinsp;13.42, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001]. The antenatal education group scored significantly higher than the control group.\u003c/p\u003e\u003cp\u003eThe repeated ANOVA with Greenhouse-Geisser correction indicated that the effects of the measures for mental well-being [F (1.82, 98.18)\u0026thinsp;=\u0026thinsp;8.02, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001] and the joint effects of repeated measures on mental well-being in the antenatal education and control groups [F (1.82, 98.18)\u0026thinsp;=\u0026thinsp;26.62, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001] were significant in favor of the antenatal education group, as Mauchly's test of sphericity was rejected (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) during the analysis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipants' repeated-measures two-way ANOVA results\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSource of Variance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSum of Squares\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003edf\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMeanSquare\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eŋ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eW-DEQ\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMeasurement\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e35552.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e21517.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e170.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.635\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMeasurement*Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43873.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e26553.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e210.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.682\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eError (Measurement)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20441.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e161.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e126.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003ePSS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMeasurement\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1442.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e804.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e23.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.191\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMeasurement*Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2727.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1521.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e43.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.309\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eError (Measurement)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6110.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e175.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e34.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eMSPSS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMeasurement\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e858.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e533.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.089\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMeasurement*Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1206.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e749.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e13.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.120\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eError (Measurement)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8809.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e157.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e55.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eWEMWBS\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMeasurement\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e538.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e295.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e8.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.076\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMeasurement*Group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1785.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e980.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e26.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.214\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eError (Measurement)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6573.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e178.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e36.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003eW-DEQ: Wijma Delivery Expectancy/ExperienceQuestionnaire, PSS: PerceivedStressScale, MSPSS: MultidimensionalScale of PerceivedSocialSupport, WEMWBS: Warwick-Edinburgh MentalWell-BeingScale\u003c/em\u003e,\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis research indicated that antenatal education reduced fear of childbirth, improved mental health, and decreased perceived stress levels both during pregnancy and postpartum. It can be suggested that antenatal education may play a significant role in reducing the fear of birth in primiparous pregnant women. Several experimental studies have also validated the efficacy of antenatal training courses in reducing women's fear of childbirth [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Furthermore, a recent study found that women who received antenatal education scored significantly lower on childbirth fear than those who did not [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It has been published in the scientific literature that fear of birth can stem from misinformation, negative perceptions, and biases [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Antenatal education can effectively mitigate these fears by providing women with accurate information about childbirth, correcting misconceptions, and promoting positive perceptions.\u003c/p\u003e\u003cp\u003eThis study provides support for the idea that antenatal education can reduce stress symptoms and improve mental health in primiparous pregnant women during pre-and postnatal periods. According to recent research, attending antenatal education can have a positive impact on the mental health of pregnant and postpartum women [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResearch has shown that participating in training courses may reduce anxiety symptoms, while information received during pregnancy can minimize birth-related stress [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Expectant first-time mothers who undergo psychological preparation for childbirth have also reported lower levels of anxiety and depression [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Furthermore, an 8-week childbirth education program has been shown to decrease depression scores and promote lower anxiety and stress levels during the postpartum period [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Another study conducted in Turkey supports these findings, indicating that antenatal education can lead to reduced symptoms of depression, anxiety, and stress both during and after pregnancy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study has certain limitations that should be taken into account. It was conducted in a single hospital and focused on primiparous pregnant women with a severe fear of childbirth. As a result, the generalizability of the findings may be limited. Notwithstanding these constraints, there are some notable strengths to our study. It was a single-blind randomized controlled trial, revealing that antenatal education may be effective and feasible. Moreover, our study delved into the social support and psychological status of women, which is a significant difference from previous research. Overall, our findings provides valuable insights into the efficacy of antenatal education in enhancing the psychological well-being of pregnant women.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAntenatal education may be beneficial in alleviating the fear of childbirth, improving mental health, and reducing stress symptoms during and after childbirth. Therefore, it may be worth considering routine implementation of antenatal education as a standard component of prenatal care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWijma Delivery Expectancy/ Experience Questionnaire (W-DEQ)\u003c/p\u003e\n\u003cp\u003ePerceived Social Support (MSPSS)\u003c/p\u003e\n\u003cp\u003eWarwick-Edinburgh Mental Well-Being Scale (WEMWBS)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their sincere gratitude to all the women who willingly participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLK: Conceptualization, Data Curation, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing. YB: Formal Analysis, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003eEK: Conceptualization, Formal analysis, Writing \u0026ndash; Original Draft, Writing \u0026ndash;Review \u0026amp; Editing. UE: Conceptualization, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing. ZK: Data Curation, Writing \u0026ndash; Original Draft, Writing \u0026ndash; Review \u0026amp; Editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe database was managed in accordance with applicable privacy legislation, and the study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The study was approved by the Ethics Committee of the University of Health Sciences, Zeynep Kamil Women and Children\u0026rsquo;s Diseases Training and Research Hospital (Approval number: 73; Date: 08.06.2022). Written and verbal informed consent was obtained from all participants prior to inclusion in the study. The trial is registered on ClinicalTrials.gov (Ref. No: NCT05584618).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSpiby H, Stewart J, Watts K, Hughes AJ, Slade P. The importance of face to face, group antenatal education classes for first time mothers: A qualitative study. 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The effectiveness of prenatal intervention on pain and anxiety during the process of childbirth‑Northern Iran: clinical trial study. Ann Med Health Sci Res. 2015;5(5):348-352. \u003c/li\u003e\n\u003cli\u003ePonting C, Chavira DA, Dunkel Schetter C, Urizar Jr, GG. Cognitive behavioral stress management effects on prenatal anxiety among low-income women. J Consult Clin Psychol. 2022;90(2):148. \u003c/li\u003e\n\u003cli\u003eHassanzadeh R, Abbas-Alizadeh F, Meedya S, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M. Fear of childbirth, anxiety and depression in three groups of primiparous pregnant women not attending, irregularly attending and regularly attending childbirth preparation classes. BMC Women\u0026apos;s Health. 2020;20:180. \u003c/li\u003e\n\u003cli\u003ePan WL., Chang CW, Chen SM, Gau ML. Assessing the effectiveness of mindfulness-based programs on mental health during pregnancy and early motherhood-a randomized control trial. BMC Pregnancy and Childbirth. 2019;19(1):1-8. \u003c/li\u003e\n\u003cli\u003eKuo TC, Au HK, Chen SR, Chipojola R, Lee GT, Lee PH, et al. Effects of an integrated childbirth education program to reduce fear of childbirth, anxiety, and depression, and improve dispositional mindfulness: A single-blind randomised controlled trial. Midwifery. 2022;113:103438. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Antenatal education, fear of childbirth, stress, mental health, pregnancy","lastPublishedDoi":"10.21203/rs.3.rs-7041181/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7041181/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study aimed to investigate the the impact of antenatal education on fear of childbirth, mental well-being, and perceived stress in primiparous pregnant women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was a prospective, randomized controlled trial conducted on primiparous women with a score of 85 or above on the Wijma Delivery Expectancy/ Experience Questionnaire (W-DEQ) between October 2022 and October 2023. The pregnant women were randomized to either the antenatal education group (n = 50) or the control group (n = 50). The antenatal education group received a 6-week antenatal education program consisting of 90-minute session each week. Both groups were compared for fear of childbirth, perceived stress, and mental well-being before starting the education, after the education (between 20–36 weeks), and 6–8 weeks postpartum. The study followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt was found that the antenatal education group experienced less fear of childbirth, improved mental health, and decreased perceived stress compared to the control group (p \u0026lt; 0.0001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAntenatal education may be beneficial in alleviating the fear of childbirth, improving mental health, and reducing stress symptoms during and after childbirth. Therefore, it may be worth considering routine implementation of antenatal education as a standard component of prenatal care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial and protocol registration \u003c/strong\u003eClinical Trials; ID: NCT05584618; Date: 13.10.2022; URL: https://clinicaltrials.gov/study/NCT05584618\u003c/p\u003e","manuscriptTitle":"Effect of Antenatal Education on Fear of Childbirth, Mental Health, and Perceived Stress in Primiparous Pregnant Women: A Prospective Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-21 10:51:30","doi":"10.21203/rs.3.rs-7041181/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-14T08:19:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-02T06:36:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"232869902749190868762895192770930504209","date":"2025-09-23T03:36:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-13T04:53:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302526998424505861743245816729478065201","date":"2025-09-07T19:02:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-17T01:21:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-17T01:14:48+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-08T10:02:40+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-07T08:52:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-07-07T08:48:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"07c909ca-e706-4976-9a2c-a1539bc1de25","owner":[],"postedDate":"July 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T16:06:17+00:00","versionOfRecord":{"articleIdentity":"rs-7041181","link":"https://doi.org/10.1186/s12884-025-08544-6","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-12-07 15:57:16","publishedOnDateReadable":"December 7th, 2025"},"versionCreatedAt":"2025-07-21 10:51:30","video":"","vorDoi":"10.1186/s12884-025-08544-6","vorDoiUrl":"https://doi.org/10.1186/s12884-025-08544-6","workflowStages":[]},"version":"v1","identity":"rs-7041181","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7041181","identity":"rs-7041181","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}