Two‑way interaction effects of psychosocial factors during pregnancy on maternal quality of life in Ibadan, Nigeria: a cross-sectional study 10.55131/jphd/2023/210220

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Olubukola Wellington


During pregnancy, women are exposed to various psychosocial stressors that affect their quality of life, but few studies have looked at them additively in non-western contexts. This study aimed to assess the shared and unique contributions of perceived stress, financial strain, intimate partner violence, food insecurity, and social support to maternal quality of life. Data were gathered from a cross-sectional sample of 519 pregnant women who received antenatal care at various primary health care centers in Ibadan, Nigeria. Independent effects of and two-way interactions between psychosocial stressors in predicting maternal quality of life were explored using hierarchical linear regression. Higher scores for the main effects of food insecurity (β = -0.52, p < 0.01) and social support (β = 0.11, p < 0.01) were most strongly linked to a lower and better quality of life, respectively. Further, the two-way interaction effects were significant for financial strain in combination with intimate partner violence (β = -0.18, p < 0.01) and food insecurity in combination with social support (β = 0.18, p < 0.01) contributing to lower quality of life. The findings of this study were supported by the social determinants of health model, which recognizes that a person’s socioeconomic environment and psychosocial state affect his or her health and life experiences. It is recommended that health care practitioners should incorporate assessments of clinical factors of gestation with those of psychosocial needs as part of routine antenatal care in order to develop appropriate women-centered interventions.

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Wellington O. Two‑way interaction effects of psychosocial factors during pregnancy on maternal quality of life in Ibadan, Nigeria: a cross-sectional study: 10.55131/jphd/2023/210220. J Public Hlth Dev [Internet]. 2023 May 16 [cited 2024 Apr. 24];21(2):241-54. Available from:
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Author Biography

Olubukola Wellington, Department of Behavioural Studies, Redeemer’s University, Ede, Osun State, Nigeria

Department of Behavioural Studies, Redeemer’s University, Ede, Osun State, Nigeria


Jomeen J, Martin C. Perinatal quality of life: is it important for childbearing women? Pract Midwife. 2012;15(4):30-4.

Oviedo-Caro MA, Bueno-Antequera J, Munguía-Izquierdo D. Explanatory factors and levels of health-related quality of life among healthy pregnant women at midpregnancy: A cross-sectional study of The PregnActive Project. J Adv Nurs. 2018;74(12):2766-76. doi: 10.1111/jan.13787.

The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;41(10):1403-9. doi: 10.1016/ 0277-9536(95)00112-k.

Mohamadian H, Eftekhar H, Rahimi A, Mohamad HT, Shojaiezade D, Montazeri A. Predicting health-related quality of life by using a health promotion model among Iranian adolescent girls: a structural equation modeling approach. Nurs Health Sci. 2011;13(2):141-8. doi: 10.1111/j.1442-2018.2011.00591.x.

National Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018 [Internet]. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF. 2019. Available from: https:/ /

World Health Organization, UNICEF, United Nations Population Fund and The World Bank, Trends in Maternal Mortality: 2000 to 2020 Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. WHO, Geneva [Internet]. 2023 [cited 2023 Apr 28]. Available from: https://

Osunu PT, Ofili CC, Nwose EU. Maternal mortality in Nigeria: A consideration of infection control factor. Prev Med Commun Health. 2021;4:1-3. doi: 10.15761/ PMCH.1000158.

Nasir N, Aderoba AK, Ariana P. Scoping review of maternal and newborn health interventions and programmes in Nigeria. BMJ Open. 2022;12(2):e054784.

World Health Organization (WHO). What are social determinants of health? Geneva: WHO. 2015 [cited 2023 Apr 28]. Available from: http://www.

Amjad S, MacDonald I, Chambers T, Osornio-Vargas A, Chandra S, Voaklander D, et al. Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: A systematic review and meta-analysis. Paediatr Perinat Epidemiol. 2019;33(1):88-99. doi: 10.1111/ppe.12529.

Traylor CS, Johnson JD, Kimmel MC, Manuck TA. Effects of psychological stress on adverse pregnancy outcomes and nonpharmacologic approaches for reduction: an expert review. Am J Obstet Gynecol MFM. 2020;2(4): 100229. doi: 10.1016/j.ajogmf. 2020.100229.

Vinturache A, Stephenson N, McDonald S, Wu M, Bayrampour H, Tough S. Health-related quality of life in pregnancy and postpartum among women with assisted conception in Canada. Fertil Steril. 2015;104(1):188-95.e1. doi: 10.1016/j.fertnstert.2015.04.012.

Tavoli Z, Tavoli A, Amirpour R, Hosseini R, Montazeri A. Quality of life in women who were exposed to domestic violence during pregnancy. BMC Pregnancy and Childbirth. 2016;16(1):19. doi: 10.1186/s12884-016-0810-6

Crosswell AD, Lockwood KG. Best practices for stress measurement: How to measure psychological stress in health research. Health Psychol Open. 2020;7(2):2055102920933072. doi: 10.1177/2055102920933072.

Elsenbruch S, Benson S, Rücke M, Rose M, Dudenhausen J, Pincus-Knackstedt MK, et al. Social support during pregnancy: effects on maternal depressive symptoms, smoking and pregnancy outcome. Hum Reprod. 2007;22(3):869-77. doi: 10.1093/humrep/del432.

Burns ER, Farr SL, Howards PP. Stressful life events experienced by women in the year before their infants' births--United States, 2000-2010. MMWR Morb Mortal Wkly Rep. 2015;64(9):247-51.

Ashagidigbi WM, Orilua OO, Olagunju KA, Omotayo AO. Gender, Empowerment and Food Security Status of Households in Nigeria. Agriculture. 2022;12(7):956. doi:

Lima R, Batista RFL, Ribeiro MRC, Ribeiro CCC, Simões VMF, Lima Neto PM, et al. Prepregnancy body mass index, gestational weight gain, and birth weight in the BRISA cohort. Rev Saude Publica. 2018;52:46. doi: 10.11606/s1518-8787.2018052000125.

Howell EA. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clin Obstet Gynecol. 2018;61(2):387-99. doi: 10.1097/GRF.0000000000000349.

Moafi F, Kazemi F, Samiei Siboni F, Alimoradi Z. The relationship between food security and quality of life among pregnant women. BMC Pregnancy Childbirth. 2018;18(1):319. doi: 10.1186/s12884-018-1947-2.

Eick SM, Meeker JD, Swartzendruber A, Rios-McConnell R, Brown P, Vélez-Vega C, et al. Relationships between psychosocial factors during pregnancy and preterm birth in Puerto Rico. PLOS ONE. 2020;15(1):e0227976. doi: 10.1371/journal.pone.0227976.

Natamba BK, Mehta S, Achan J, Stoltzfus RJ, Griffiths JK, Young SL. The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study. Matern Child Nutr. 2017;13(3). doi: 10.1111/mcn.12351.

Garman EC, Schneider M, Lund C. Perinatal depressive symptoms among low-income South African women at risk of depression: trajectories and predictors. BMC Pregnancy Childbirth. 2019;19(1):202. doi: 10.1186/s12884-019-2355-y.

Vachkova E, Jezek S, Mares J, Moravcova M. The evaluation of the psychometric properties of a specific quality of life questionnaire for physiological pregnancy. Health Qual Life Outcomes. 2013;11:214. doi: 10.1186/1477-7525-11-214.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385-96.

Sherin KM, Sinacore JM, Li XQ, Zitter RE, Shakil A. HITS: a short domestic violence screening tool for use in a family practice setting. Fam Med. 1998;30(7):508-12.

Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide. Washington, DC: Food and Nutrition Technical Assistance Project, Academy for Educational Development. 2007

Conger RD, Elder GH Jr. Families in troubled times: The Iowa Youth and Family Project. In R. D. Conger, G. H. Elder Jr., editors. Families in troubled times: Adapting to change in rural America Hawthorne. NY: Aldine de Gruyter; 1994. p. 3–16.

Nguyen TH, Ngo TV, Nguyen VD, Nguyen HD, Nguyen HTT, Gammeltoft T, et al. Intimate partner violence during pregnancy in Vietnam: prevalence, risk factors and the role of social support. Glob Health Action. 2018;11(sup3):1638052. doi: 10.1080/ 16549716.2019.1638052.

Hair JF Jr., Anderson RE, Tatham RL, Black WC. Multivariate Data Analysis; 3rd ed. New York: Macmillan; 1995.

James G, Witten D, Hastie T, Tibshirani R. An Introduction to Statistical Learning: With Applications in R. 1st ed. Springer; 2013.

Augusto ALP, de Abreu Rodrigues AV, Domingos TB, Salles-Costa R. Household food insecurity associated with gestacional and neonatal outcomes: a systematic review. BMC Pregnancy Childbirth. 2020;20(1):229. doi: 10.1186/s12884-020-02917-9.

Abrahams Z, Lund C, Field S, Honikman S. Factors associated with household food insecurity and depression in pregnant South African women from a low socio-economic setting: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol. 2018;53(4):363-72. doi: 10.1007/s00127-018-1497-y.

Richards M, Weigel M, Li M, Rosenberg M, Ludema C. Household food insecurity and antepartum depression in the National Children's Study. Ann Epidemiol. 2020;44:38-44.e1. doi: 10.1016/j.annepidem.2020.01.010.

World Bank. Advancing social protection in a dynamic Nigeria [Report ASA P165426] [Internet]. 2019. Available from: https://documents1.

Liverpool-Tasie LS, Kuku O, Ajibola A. Review of literature on agricultural productivity, social capital and food security in Nigeria. IFPRI. 2011;21:1-53.

Finnbogadóttir H, Dykes AK, Wann-Hansson C. Prevalence and incidence of domestic violence during pregnancy and associated risk factors: a longitudinal cohort study in the south of Sweden. BMC Pregnancy Childbirth. 2016;16:228. doi: 10.1186/s12884-016-1017-6.

Field S, Onah M, van Heyningen T, Honikman S. Domestic and intimate partner violence among pregnant women in a low resource setting in South Africa: a facility-based, mixed methods study. BMC Womens Health. 2018;18(1):119. doi: 10.1186/s12905-018-0612-2.

Thomson K, Moffat M, Arisa O, Jesurasa A, Richmond C, Odeniyi A, et al. Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis. BMJ Open. 2021;11(3):e042753. doi: 10.1136/bmjopen-2020-042753.

Drentea P, Reynolds JR. Where Does Debt Fit in the Stress Process Model? Soc Ment Health. 2015;5(1):16-32. doi: 10.1177/2156869314554486.

Lin HF, Postmus JL, Hu H, Stylianou AM. IPV Experiences and Financial Strain Over Time: Insights from the Blinder-Oaxaca Decomposition Analysis. J Fam Econ Issues. 2022:1-13. doi: 10.1007/s10834-022-09847-y.

Halim N, Beard J, Mesic A, Patel A, Henderson D, Hibberd P. Intimate partner violence during pregnancy and perinatal mental disorders in low and lower middle income countries: A systematic review of literature, 1990-2017. Clin Psychol Rev. 2018;66:117-35. doi: 10.1016/j.cpr.2017.11.004.