Iran Journal of Nursing

Introduction
Pregnancy is a physiological condition that is associated with many physical and psychological changes. Pregnancy in adolescence is a serious public health concern that affects the health of the mother and the child and affect the quality of life (QoL) of mother. In developed countries, 1 in 3,800 adolescent girls dies from pregnancy, while in developing countries it is 1 in 150 adolescent girls. Each year, about 3.9 million adolescents aged 15-19 have an unsafe abortion. The risk of mortality due to pregnancy in adolescents aged 15-19 years is twice the risk in the age group >20 years and in the group of 10-14 years, the risk is 5 times higher than in adults. This increases the risk of maternal mortality and health problems and has negative emotional effects on adolescents. Therefore, this study aims to determine the QoL in adolescent pregnant women referring in Arak, Iran.
Method
This cross-sectional study was conducted on 217 adolescent pregnant women referred to comprehensive health centers in urban areas of Arak city in 2020 who were selected by a multi-stage sampling method. Demographic form and quality of the quality of life gravidarum questionnaire (QoL-GRAV) were used to collect information where the lower score shows the higher QoL. Descriptive statistics were used to describe the data and independent t-test, analysis of variance, and Pearson correlation test in SPSS v.22 software were used to examine the relationship between the study variable and demographic/obstetric factors. Significance level was set at 0.05.
Results
The mean age of participants was 17.86±1.42. The mean total QoL score was 1.83, which was lower than the median score of 3. They had the highest score in psychological health domain (Mean=2.01). Participants had the lowest average score in the social functioning domain (Mean=1.5), which was lower than the median score. Women’s educational level, husband’s educational level, economic status, and pregnancy status (unplanned/planned) according to women and their husbands had a significant relationship with the QoL. The mean score of QoL in women with primary education was significantly higher than in those with middle school and high school education, indicating their poor QoL. 
Discussion
The results of this study showed that the QoL of adolescent pregnant women in Arak is higher than the average. Among the domains of QoL, psychological health showed the highest score, while social functioning had the lowest score, which indicates that the QoL of pregnant adolescents was higher in social functioning than other domains. The pregnant women with higher educational level, those with husbands with higher educational level, those with better economic status, and those with planned pregnancy had better QoL. It seems that the childbirth preparation programs and the emphasis of health centers on the participation of pregnant mothers in these courses in recent years and the teaching of relaxation techniques have played an effective role in reducing the problems of mothers, especially adolescent pregnant women, and have thus increased their QoL. In addition, family support and education of husbands to support their pregnant wives, have played an important role in reducing the stress and depression of pregnant mothers and have thus improved the QoLin the social functioning domain.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1399.521). 

Funding
The paper was extracted from the MSc. Dissertation of Maryam Amini, Department of Reproductive Health and Midwifery, Faculty of Nursing and Midwifery, Iran University of Medical Sciences. This research was supported by the research project (No. 18330), Funded by Iran University of Medical Sciences. 

Authors' contributions 
Conceptualization, Methodology and Supervision: Maryam Gharacheh and Maryam Amini; Data collection: Maryam Amini; Data analysis: Shima Haghani and Batool Hasanpoor-Azghadi; Funding acquisition and Resources: Maryam Gharacheh; Investigation, Writing – original draft, and Writing – review & editing: All authors.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors acknowledged the vise chancellor for research of Iran University of Medical Sciences and school of Nursing and Midwifery, and all the women participated in this study.

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