Family Support to Women During Pregnancy and Its Impact on Maternal and Fetal Outcomes

Background: Family support is one of the determinants of lifestyle habits and relevant health behavior for pregnancy outcomes. In India, the joint family system is still practiced. Due to education, urbanization, and industrialization, the family institution continues to play a central role in people's lives. Pregnancy is a crucial period in women’s lives. Good care during pregnancy is important for the health of the mother and the newborn baby. During this period, hormonal changes are complex and involve multiple hormones working together to support the developing fetus and prepare the mother's body for labor, delivery, and breastfeeding. To avoid maternal and fetal complications, she needs support from her family throughout pregnancy and the postnatal period. Aim and objectives: This study aims to evaluate the influence of the level and quality of family support during pregnancy on maternal and fetal outcomes and to identify any association between the sociodemographic variables and the impact of the level and quality of family support during the first trimester. Material and methods: This study used a quantitative approach with a survey research design. Data were collected from four Primary Health Centers at Karad, Maharashtra, India, i.e., Rethare, Vadgaon, Kale, and Supane. A consecutive sampling technique was used to select the 344 subjects from the Rethare, Vadgaon, Kale, and Supane areas of Karad Taluka. Data were collected before the completion of the first three months of pregnancy, then during the second trimester and after delivery. Upon evaluation, the tool was validated by experts representing a range of specialties, including community health nursing, mental health nursing, obstetric gynecology, and pediatric care. A pilot study was conducted on 30 samples. The data collected were analyzed by using descriptive and inferential statistics. Result: The findings of the study show a significant association between the psychosocial support received in the first trimester and the total gestational weeks completed at the time of delivery (p < 0.05). The study suggests the need for psychosocial support during the first trimester for better maternal and fetal outcomes. Conclusion: Psychosocial family support is needed by pregnant women during the first trimester to achieve maternal and fetal outcomes.


Introduction
Understanding whether low support is responsible for the increased risk of preterm birth could help health professionals identify women early in pregnancy and connect them with appropriate support [1].Children of pregnant women tend to have low birth weight (LBW), fail to grow at a normal rate, and have higher rates of obtaining disease, potentially leading to early death due to lack of family support [2].Throughout pregnancy, women need support from the family to gain better maternal and fetal outcomes [3].Emotional distress in women during pregnancy has been shown to increase the risk of adverse outcomes for women and newborns [4].Maternal mortality is unacceptably high.About 2,95,000 women died during and after pregnancy and childbirth in 2017.Most of these deaths (94%) occurred in low-resource settings, and most could have been prevented [5].Family support, including the husband's role as the head of the family, is crucial during pregnancy.Pregnancy, the longest nine-month period of their lives, is a period characterized by heightened emotions, and caring for a newborn can be exhausting.During this time, individuals need to have the support of close relatives who can assist with caring for both the mother and the baby.Helping these relationships to meet health needs is important for the woman and the newborn baby [6].
The present study was conducted at four Primary Health Centres (PHCs) in the rural area of Karad Taluka, Maharashtra, India, from 2021 to 2023.There are 11 PHCs in Karad Taluka; initially, out of 11 PHCs, a random selection of four PHCs was done.The desired 344 samples were collected from 40 selected villages.The participants for the current study included first-time and multiple-time pregnant women aged 18-30 years who were residents registered and gave birth at the selected PHCs of Karad Taluka or at Krishna Hospital Karad.
Ethical permission for the study was obtained through Krishna Vishwa Vidyapeeth (Deemed to be University), registration number KIMSDU/PhD/Adm./13/2020.Women were enrolled using a consecutive sampling technique.This method involved enrolling all eligible women from conception until three months of pregnancy, provided they met the study's inclusion and exclusion criteria.Enrollment was continuous as these women visited the selected PHCs in Karad Taluka.During the initial visit, participants underwent screening according to the inclusion criteria, and informed consent was obtained before enrolling pregnant women in the study.Data were collected during three subsequent visits: the first visit within the first three months after conception, the second during the second trimester, and the final visit after delivery.The independent variable was the level of family support, and the dependent variable was the maternal and fetal outcomes.In the first trimester, 103 (29.9%) women received strong support, 175 (50.9%) received moderate support, and 66 (19.2%) received poor family support, encompassing physical, emotional, and psychosocial aspects.Figure 1 shows the schematic of the research design.

FIGURE 1: Schematic of the research process
The sampling technique involves selecting representative units of the target population.It is the process of choosing a portion of the population.The study utilized a consecutive sampling technique.The sample size of 344 pregnant women was calculated based on the findings of the study conducted by Abdollahpour et al. [7].The proportion of pregnancy complications observed in women [7] with poor support from family was 81.8%, while the proportion of pregnancy complications in women with moderate or good support from families was 45.2%.The pregnant woman who needed to be enrolled in the current study was determined as follows: where p1 is the proportion of women having pregnancy complications with poor/moderate family support; q1 = 100-p1; p2 is the proportion of women having pregnancy complications with good family support; q2 = 100-p2; Z1-oe/2 = level of significance (5%), i.e., = 1.96;Z1-ß = power of the study (95%), i.e., 1.64; i.e. = 1.96Z1-ß = power of the study (95%), i.e., =1.64.Thus, n = 39 Approximately 10% of women might not complete the follow-up periods from conception to the postpartum period in the study.A minimum of 43 (i.e., 39 + 3) women with varying levels of family support (poor, moderate, and good) were enrolled from four randomly selected PHCs under Karad Taluka.There are 11 PHCs in Karad Taluka, out of which four PHCs were chosen randomly for the study.The sample size is n = 344.

Criteria for the selection of the sample
The inclusion criteria concerned pregnant women aged 18 to 30, primigravida and multigravida women, who visited selected PHCs under Karad Taluka, registered within three months of pregnancy and delivered under allotted PHCs, health care settings, or Krishna Hospital, Karad.
Exclusion criteria included pregnant women who suffered severe disorders or disability during the first trimester, had a history of drug or alcohol abuse, were diagnosed with mental illnesses, or were not interested.
Data collection instrument: The pregnancy outcome was categorized based on the type of delivery: preterm (<37 weeks of pregnancy), term (37-42 weeks of pregnancy), and post-term delivery (>42 weeks of pregnancy).Mode of delivery options included spontaneous vaginal delivery, assisted vaginal delivery, lower segment cesarean section, or forceps/vacuum delivery.Fetal outcome encompasses the baby's birth weight, with an LBW baby defined as having a birth weight of less than 2.5 kg and a normal baby having a birth weight of 2.5 kg or greater.The baby's birth status includes whether the baby was born normally or had any complications.The length of the baby and family support received for baby care were calculated.The quality and level of family support, including physical, emotional, and psychosocial support, should be categorized as poor, moderate, or good during each trimester and the postnatal period.

Results
Table 1 shows that 50 women (14.5%) received good physical support during the first trimester, 196 (57%) received moderate physical support, and 98 (28.5%) received poor physical support during the first trimester.During the first trimester, 65 (18.9%)pregnant women received good emotional support, 169 (49.1%) received moderate support, and 110 (32%) received poor support.According to the psychosocial support survey, 56 individuals (16.3%) reported receiving good psychosocial support, 181 (52.6%) reported receiving moderate support, and 107 (31.1%) reported receiving poor support.In total, in the first trimester, 103 (29.9%) received good family support, 175 (50.9%) received moderate support, and 66 (19.2%) received poor support.Table 3 shows that there was no significant association found between gestational weeks completed at the time of delivery, presence of associated maternal complications/diseases during pregnancy, presence of close relatives before delivery, relationship with the attendee, presence of maternal complications during delivery, specific maternal complication, type of delivery, received family support during delivery, relationship with the attendee, family support received after delivery, relationship with the attendee, and emotional support during the first trimester.Table 5 shows that there was a significant association found between received family support during delivery and the level of total support during the first trimester (p < 0.05).No significant association was found between gestational weeks completed at the time of delivery, presence of associated maternal complications/diseases during pregnancy, presence of close relatives before delivery, relationship with the attendee, presence of maternal complications during delivery, specific maternal complication, type of delivery, relationship with the attendee, family support received after delivery, relationship with the attendee, and maternal outcome with total family support during the first trimester (p > 0.05).P value was calculated by the chi-square method N: sample size; n: number of participants included; LBW = low birth weight; FD: full-term delivery

Maternal outcome
From Table 8, it was found that there was a significant association between the level of psychosocial support and the attendee supporting baby care (p < 0.05).However, no significant association was found between psychosocial support during the first trimester and the following factors: health of the newborn at birth; weight of baby at delivery; length of the present baby; any abnormalities in the baby; if yes, specify abnormality; the baby's sex; and fetal outcome (p > 0.05).Table 9 shows that no significant association was found between the length of the present baby, its sex, the relationship with the attendee supporting baby care, and the level of total family support during the first trimester (p > 0.05).

Discussion
In this research study, 56 participants (16.3%) received good psychosocial support, 181 (52.6%) received moderate support, and 107 (31.1%) received poor psychosocial support.The present study demonstrated results similar to those of a study conducted by Abdollahpour et al. [7].The study used the perceived social support from the family scale and found that 1.3% of women had poor family support, 27.9% had moderate family support, and 69% had good family support.In both studies, the majority of women received moderate support.Due to family support, early diagnosis and prevention of any complications can be ruled out.
In this study, no significant association was found between the types of delivery, complications during delivery, received family support during delivery, relationship with the attendee, and family support received after delivery with psychosocial support in the first trimester of pregnancy (p > 0.05).These findings are similar to those of Allendorf [8], who investigated the quality of family relationships and maternal health.It was found that there was no significant correlation between social support and the type of delivery, birth weight, number of prenatal care visits, and obstetric complications (p > 0.05).These results suggest that while social support, including family support, may not significantly impact specific delivery outcomes, it is still crucial for overall maternal well-being during pregnancy.
This study's findings show that during the first trimester, women need support due to morning sickness and other physiological changes.The results of the study by Lutterodt et al. [9] indicated that in the first trimester, most women experienced more than one symptom.While many women accepted these symptoms, those involving pain or bleeding were particularly concerning, and nausea frequently caused minor worries for about one-fifth of women.During pregnancy, women need assistance and support from their families and care providers to address their worries.Our study found a significant association between pregnancy acceptance and physical support during the first trimester (p < 0.05).
In the present study, good family support had shown an impact on maternal and fetal outcomes, similar to those who received support and had normal delivery.The study showed that out of 344 participants, only 80 (23.26%) husbands supported pregnant women during the first trimester, providing emotional security, mental peace, and improved physical health.A study by Sokoya et al. in Nigeria demonstrated that 86% of the women who were supported by their husbands experienced less stress during pregnancy, feeling emotionally secure and physically healthy [10].A recent study found that the importance of family support during the first trimester of pregnancy can enhance maternal and fetal outcomes.This period is marked by significant physical and emotional changes, making it a vulnerable time for expectant mothers.In the present study, good family support was shown to impact maternal and fetal outcomes positively.
This research found a significant association between psychosocial support received in the first trimester and total gestational weeks completed at the time of delivery (p < 0.05).This study selected both multi and primigravida mothers.A majority of 195 respondents (56.6%) were identified as housewives and indicated that they rely on family members to make decisions regarding their visits to the doctor.A study conducted by Prabhu et al. [11] selected both multi and primigravida mothers; there was a substantial association between maternal age and prenatal depression; the majority of the study participants were housewives who were financially dependent on their partners.
In the current study, it is important to note that support for women from both their husbands and their inlaws is crucial.It will help to achieve healthy maternal and fetal outcomes.Out of 344 participants, 168 (48.83%) received support from mothers, 42 (12.20%)from husbands, 37 (10.75%) from mother-in-laws, and 10 women (2.91%) received support from other relatives.In this study, it is demonstrated that 87 women (25.29%) did not receive support from any of their relatives.Fatigue experienced during pregnancy encompasses physical, psychological, and emotional aspects, as indicated by Naz et al. [12].Healthy pregnancy outcomes are directly proportional to the care taken by mother-in-laws and husbands, who are the key people.They felt helpless when no one listened to their health problems [12][13][14].
Policy implications for family support during pregnancy: Research suggests that promoting family involvement and support during pregnancy is crucial for optimal maternal and child health outcomes.Healthcare policies and interventions should be evidence-based and designed to foster an environment where families are actively engaged and supported throughout the pregnancy journey.By adopting these recommendations, healthcare systems can improve health outcomes for both mothers and their babies, ultimately contributing to healthier families and communities.

Conclusions
The study's conclusion highlights the significant role of family support in achieving positive maternal and fetal outcomes during pregnancy.Specifically, when women experience symptoms like morning sickness and physiological changes during the first trimester, family support becomes crucial for ensuring good outcomes.The study suggests that receiving adequate family support during this period is associated with improved maternal and fetal health, as evidenced by a higher likelihood of normal delivery among women who received support.As reported by study participants, the impact of the husband's support was perceived to provide emotional security, mental peace, and improved physical health for pregnant women.However, the study also reveals that only a minority of husbands (23.26%) provided support during the first trimester, indicating a potential area for improvement in terms of spousal support during pregnancy.Furthermore, the study identifies a significant association between attendees supporting baby care and the level of psychosocial support (p < 0.05).This underscores the importance of psychosocial support during the first trimester, highlighting the need for interventions that address the psychological and social well-being of pregnant women.The study emphasizes the vital role of family support, particularly from husbands, in ensuring positive maternal and fetal outcomes during pregnancy, especially during the first trimester.

TABLE 2 : Association between maternal outcome and the level of physical support during the first trimester (N = 344)
P value was calculated by the chi-square method N: sample size; n: number of participants included; PPH: postpartum hemorrhage

Table 4
shows that there was a significant association found between psychosocial support received in the first trimester and total gestational weeks completed at the time of delivery (p < 0.05).No significant association was found between the presence of associated maternal complications/diseases during pregnancy, presence of close relatives before delivery, relationship with the attendee, presence of maternal complications during delivery, specific maternal complication, type of delivery, received family support during delivery, relationship with the attendee, and family support received after delivery with psychosocial support at the first trimester during pregnancy (p > 0.05).2024 Mane et al.Cureus 16(6): e62002.DOI 10.7759/cureus.62002Received family support during delivery

TABLE 4 : Association between maternal outcome and the level of psychosocial support during the first trimester (N = 344)
P value was calculated by the chi-square method N: sample size; n: number of participants included; PPH: postpartum hemorrhage

TABLE 5 : Association between maternal outcome and the level of total support during the first trimester (N = 344)
P value was calculated by the chi-square method N: sample size; n: number of participants included; PPH: postpartum hemorrhage

Table 6
indicates that there was no significant association between the health of the newborn at birth, birth weight, height, abnormalities, complications, sex of the baby, received family support for feeding, relationship with the attendee, and physical support with the fetal outcome during the first trimester (p > 0.05).

TABLE 6 : Association between fetal outcome and the level of physical support during the first trimester
(N = 344) P value was calculated by the chi-square method N: sample size; n: number of participants included; LBW: low birth weight From Table7, it was found that there was no significant association between the following factors and fetal outcome during the first trimester: birth status, birth weight, height, any abnormality in the baby, any complications, sex of the present baby, received family support for baby care, relationship with the attendee, and emotional support (p > 0.05).