The Relationship Between Fetal Health Anxiety, Spiritual Well-Being, and Perceived Social Support in High-Risk Pregnant Women in Türkiye

Pregnancy incorporates a wide range of emotions and experiences. Concerns regarding the health of the fetus are a significant dimension of this period. In particular, these concerns become more pronounced in cases of high-risk pregnancies, potentially exacerbating the stress experienced by pregnant women (Baltacı & Vatansever, 2024; Isaacs & Andipatin, 2020). In such pregnancies, maintaining a healthy course may require lifestyle adjustments, medical support, and even hospitalization. However, these interventions can lead to substantial lifestyle changes, including distancing the pregnant woman from her family and limiting her prior daily activities (Palma et al., 2021). This process often intensifies the focus on the fetus’s health, thereby heightening fetal health anxiety. Fetal health anxiety refers to the expectant mother’s worries concerning the health of her fetus (Reiser, 2019). In the literature, fetal health anxiety is considered one of the most prevalent and intense concerns during pregnancy (Reiser & Wright, 2019). Particularly in high-risk pregnancies, this anxiety can subject pregnant women to both physically and emotionally challenging experiences. At this point, spiritual well-being and perceived social support may play a significant role in managing the anxiety experienced by pregnant women (Hosaini et al., 2023).

Spiritual well-being refers to an individual’s ability to focus on their lives in line with adding value, meaning, and purpose. This attribute not only improves psychological functioning but also promotes stability, tranquility, and coordination in life. Additionally, it fosters closer relationships with oneself, a higher power, society, and the environment (Tirgari et al., 2022). Previous studies indicate that spirituality is effective in improving tolerance toward life challenges, enhancing life satisfaction, and coping with adversities (Akbarzadeh & Ahmadinezhad, 2019; Nourimand et al., 2020). Particularly in high-risk pregnancies, spiritual well-being was reported to positively influence stress management. For instance, a study carried out on pregnant women diagnosed with preeclampsia revealed that a higher level of spiritual well-being is related to reduce perceived stress (Akbarzadeh & Ahmadinezhad, 2019). Similarly, spiritual well-being is reported to improve coping skills and reduce fetal health anxiety in high-risk pregnancies (Chehrazi et al., 2021).

Social support refers to the emotional, material, or knowledge support that individuals receive through their connections with family members, friends, groups, and communities (Ozbay et al., 2007). Social support is a significant factor that positively affects women’s health, particularly during pregnancy, childbirth, and the postpartum period (Akbari et al., 2020). Strong social support networks reduce psychological distress during pregnancy and improve coping skills for managing stress (Bedaso et al., 2021; Karakoç et al., 2023). Moreover, it was emphasized that pregnant women with robust social support networks report higher levels of spiritual well-being (Akbarzadeh & Ahmadinezhad, 2019), which, in turn, may contribute to alleviating fetal health anxiety.

Interventions aiming to reduce fetal health anxiety in high-risk pregnancies play a crucial role in managing this process effectively. Despite existing studies on pregnancy-related anxiety, it is evident that the relationship between spiritual well-being, social support, and fetal health anxiety in high-risk pregnancies requires further detailed study. In this context, this study aims to analyze the relationship between fetal health anxiety, spiritual well-being, and perceived social support in high-risk pregnancies. This study provides a valuable framework for developing holistic and effective approaches to managing anxiety encountered in high-risk pregnancies by addressing these factors collectively.

The mean age of the 175 pregnant participants was 27.98 ± 6.01 years. Among the participants, 35.4% had completed primary education, 15.4% were employed, and 62.3% reported an income equal to their expenses. About 33.1% of the participants had chronic illness, 74% were taking medication continuously during pregnancy. It was determined that 69.7% of pregnancies were planned, and 41.7% of the participants were primiparous (Table 1).

The median scores of the scales used in this study were found to be 16 (range: 4–41) for the FHAI and 68 (range: 12–84) for the MSPSS. The median score for the anomie subdimension of the SWBS was found to be 15, for transcendence 72, and for harmony with nature 33. There was no statistically significant difference between the median FHAI scores and sociodemographic or obstetric variables (p > 0.05). However, the median MSPSS scores varied significantly by educational level (p = 0.035), with primary school graduates scoring a median of 60, high school graduates scoring 70, and university graduates scoring 71. Additionally, MSPSS scores differed significantly based on continuous medication use during pregnancy (p = 0.049). The median MSPSS score for those using medication was 69, while it was 56.5 for those not using medication (Table 1).

The anomie subdimension of the SWBS showed a significant difference regarding the pregnancy status (p = 0.030). Multiparous pregnant women had higher anomie scores compared to primiparous pregnant women. Moreover, the transcendence and harmony with Nature subdimensions of the SWBS exhibited significant differences by income level (p = 0.025 and p = 0.003, respectively). Pregnant women whose income exceeded their expenses had higher transcendence and harmony with nature scores when compared to those whose income was equal to their expenses (Table 1).

A positive and significant correlation was found between the anomie subdimension score and FHAI (r = 0.019, p < 0.001), as well as between the harmony with nature subdimension and the MSPSS (r = 0.223, p < 0.001) (Table 2).

To examine the relationships between fetal health anxiety, spiritual well-being, and perceived social support in high-risk pregnancies, structural equation modeling (SEM) was employed. The model fit indices were calculated as CMIN = 12.006, DF = 8, CMIN/DF = 1.501, RMSEA = 0.054, CFI = 0.981, and GFI = 0.980. Considering this model, an increase in the harmony with nature score resulted in a 0.282-unit increase in the MSPSS score (β = 0.282; p = 0.023), while an increase in the anomie subdimension score led to a 0.211-unit increase in the FHAI score (β = 0.211; p = 0.005) (Table 3) (Fig. 1).

This study examined the relationships between fetal health anxiety, spiritual well-being, and perceived social support among women with high-risk pregnancies. Fetal health anxiety is one of the most common concerns; expectant mothers have regarding the health of their fetus (Reiser & Wright, 2019). The total score for fetal health anxiety was determined to be 16 in the sample of the present study. Previous studies reported lower levels of fetal health anxiety (İbici Akca et al., 2024; Reiser & Wright, 2019; Sabancı Baransel & Barut, 2024). This discrepancy may be because the study group consisted of women diagnosed with high-risk pregnancies.

In this study, the perceived social support score among participants was reported to be 68, which was found to be higher than the scores reported by Kaydırak et al. (2024) in their study on pregnant women diagnosed with fetal anomalies. During hospitalization, increased attention and support from family and friends may have strengthened the physical and emotional support mechanisms, thereby enhancing the perception of social support among these women. Sociodemographic analyses indicated that pregnant women with higher levels of education and those who were on continuous medication had higher perceived social support levels. The finding that women with higher education levels reported a higher level of perceived social support is consistent with the study carried out by Baharvand et al. (2022). Educated women may effectively utilize social support networks and exhibit greater confidence in seeking support due to better access to information and advanced communication skills. Moreover, women who used medication continuously during pregnancy were determined to have a higher level of perceived social support. Continuous medication use often necessitates heightened attention and care for health management, which could lead to greater social support from the individual’s surroundings. The increased need for care and health-related concerns may motivate these women to actively seek and receive support from others.

Spiritual well-being provides significant support in coping with the challenges and stress caused by illnesses, positively influencing individuals’ health (Akbarzadeh & Ahmadinezhad, 2019). Among the pregnant women who participated in this study, the anomie subdimension of the SWBS was found to differ based on pregnancy status. It was determined that multiparous pregnant women had higher levels of Anomie. Anomie refers to situations in which the social order is disrupted, causing individuals to become detached from social norms and values, leading to existential void and loss of direction (Ryff, 2021). Hospitalization, particularly for multiparous pregnant women, may contribute to role conflicts due to concerns related to health problems, separation from their social environment, and the inability to provide sufficient support to their other children. This situation may make it more difficult for pregnant women to adhere to social norms and roles, leading to heightened feelings of alienation. Harmony with nature is an integral component of spiritual well-being, encompassing an individual’s awareness of and adaptation to their physical environment. Transcendence, on the other hand, refers to belief in a powerful and eternal entity and the recognition of one’s own vulnerability and dependence on that entity (Ekşi & Kardaş, 2017; Fisher, 2003). Among the pregnant women in the present study, the transcendence and harmony with nature subdimensions of the SWBS were found to differ in terms of income level. Pregnant women whose income exceeded their expenses exhibited higher levels of transcendence and harmony with nature in comparison with those whose income is equal to their expenses. This result suggests that economic stability may enhance spiritual experiences and an individual’s relationship with their environment. A favorable economic situation is thought to contribute to reduced financial concerns regarding the baby, the timely fulfillment of needs, inner peace, and an increased capacity to adapt to one’s surroundings.

In this study, a negative relationship was found between spiritual well-being and fetal health anxiety among pregnant women. This result suggests that spiritual well-being could be an effective factor in reducing pregnant women’s concerns about fetal health. Nourimand et al. (2020) indicated in their study that pregnant women with higher levels of spiritual well-being exhibit better mental health and experience fewer negative emotions. Similarly, the study carried out by Oktafia et al. (2021) revealed a negative relationship between the level of spiritual well-being and anxiety in pregnant women. Studies examining the relationship between spirituality and health may sometimes yield tautological (self-referential) findings (Koenig & Carey, 2024, 2025). In this context, the positive association between the anomie subdimension of the SWBS and spiritual well-being suggests that this relationship may be associated with psychological constructs. Therefore, when assessing the anxiety-reducing effect of spiritual well-being, its interaction with psychological structures should be considered more carefully.

Unlike received social support, perceived social support refers to the support individuals believe is available to them (Feng et al., 2024). As determined in this study, the perceived social support score also increases together with an increase in level of harmony with nature. This study revealed a positive relationship between perceived social support and spiritual well-being. Similarly, previous studies reported a positive association between the level of perceived social support and spiritual well-being among pregnant women (Akbarzadeh & Ahmadinezhad, 2019; Niaghiha et al., 2019). Spiritual well-being helps individuals build strong relationships with themselves, God, and their environment (Tirgari et al., 2022). Individuals who experience a higher level of harmony with nature may develop a deeper sense of being part of the creation within their environment, thereby strengthening their perception of social support. This factor could be particularly significant in the recovery process of vulnerable groups, such as hospitalized women with high-risk pregnancies. Therefore, the integration not only of medical interventions but also of social and spiritual support into the treatment processes of pregnant women is crucial.

This study has several limitations. First, as the research was conducted in a single hospital, the data obtained may only represent the sample group and cannot be generalized. Second, the exclusive use of self-report scales completed solely by participants is thought to have increased method variance. The positive relationship between the Anomie subscale of the SWBS and the FHAI may be linked to underlying psychological structures. Therefore, the analyses were conducted based on the subscales of the measurement tools, and the results should be interpreted carefully.

It was determined in this study that hospitalized women diagnosed with high-risk pregnancies exhibited low levels of fetal health anxiety, and high levels of perceived social support. While harmony with nature was found to improve perceived social support, anomie was associated with increased fetal health anxiety. Furthermore, perceived social support levels were found to vary based on sociodemographic variables such as education level and continuous medication use. The anomie subscale of the SWBS showed significant differences based on pregnancy status, while the transcendence and harmony with nature subscales varied by income level. These results emphasize that healthcare professionals caring for women with high-risk pregnancies should not only focus not only on medical interventions but also on providing spiritual support and strengthening social support networks. The integration of a holistic approach into clinical practice could be a significant step toward improving both the physical and psychological health of pregnant women.