Qom University of Medical Sciences Journal

Introduction
Climate change refers to alterations in a region’s weather patterns expected over a long-term period based on observed or recorded data for that area. Climate change represents a broad and overall fluctuation in a region’s climate. Currently, the trend of global warming is considered part of climate change. Climate change threatens not only physical health but also mental health. The phenomenon of climate anxiety, which has emerged in recent years in environmental psychology literature as a novel concept, reflects the ongoing experience of worry, fear, and helplessness in the face of real or perceived environmental threats. Research indicates that vulnerable groups, including pregnant women, may be more susceptible to climate change due to various physiological, psychological, and psychosocial changes associated with pregnancy. This vulnerability can arise either directly through environmental disasters (such as wildfires, extreme heat, air pollution, floods, droughts, etc.) or indirectly through changes in nature and the social environment. The present study aimed to investigate the relationship between climate anxiety and prenatal worry and depression among pregnant women in Qom, Iran.
Methods 
This descriptive-analytical correlational study with a cross-sectional design was conducted from June 30 to September 13, 2024. A total of 106 pregnant women attending comprehensive health centers in Qom city were recruited. For sampling, 10 comprehensive health centers from two high-traffic health districts of Qom (districts 1 and 2) were selected using simple random sampling (lottery method). Then, eligible women willing to participate, after receiving an explanation of the study objectives and providing written informed consent, were selected using a convenience approach. The sample size was calculated to be 96 based on the study by Lykins et al. [5] and considering the correlation coefficient between climate anxiety and maternal worry. By considering a 10% sample dropout rate, it increased to 106. Data were collected using the following instruments: a) a demographic/obstetric checklist surveying demographic information (such as age, education level, occupation, economic status, and quality of marital relationships) as well as obstetric information including gestational age and number of children; b) climate change anxiety scale (CCAS): Developed by Clayton and Karazsia [24], this 22-item self-report scale evaluates psychological responses to climate change (e.g. “Thinking about climate change makes it difficult for me to concentrate”) and includes four subscales: cognitive-emotional impairment, functional impairment, personal experience of climate change, and behavioral engagement. Responses are scored on a five-point Likret scale from 1 (never) to 5 (almost always); c) cambridge worry scale (CWS): Developed by Green et al. [22], this 16-item scale assesses the content and intensity of women’s worries during pregnancy. Responses are rated on a six-point Likert scale from 0 (not a worry) to 5 (major worry), with total scores ranging from 0 to 80; d) Edinburgh postnatal depression scale (EPDS): Developed by Cox et al. [19], this scale measures the severity of postnatal depression over the past week. Although originally designed for postpartum women, subsequent studies have confirmed its validity for use in pregnant women. This 10-item questionnaire’s total score ranges from 0 to 30. The are scored from 0–3. For items 3, 5–10, scoring is reversed. The collected data were analyzed using Pearson’s correlation test and one-way analysis of variance (ANOVA) in SPSS software, version 26, with a significance level set at 0.05.
Results 
The participants’ mean age was 29.8±5.4 years, and the mean score of CCAS was 43.6±8.7. Results showed a positive and significant correlation between total CCAS score and the CWS score (r=0.25, P=0.01). The total CCAS score was also positively correlated with the EPDS score (r=0.28, P=0.003). ANOVA results indicated no significant differences in mean CCAS score based on pregnancy trimester, number of children, education level, or economic status (P>0.05). This suggests that climate anxiety is a widespread phenomenon more related to subjective perceptions of environmental threats than to sociodemographic/obstetric variables.
Conclusion
Given the positive association of climate anxiety with both prenatal worry and depression in women, it can be concluded that climate change is not only an environmental challenge but also a threat to the mental health of pregnant women. Therefore, specific psychological interventions and educational programs should be developed in health and prenatal care centers to identify, prevent, and manage climate change-related anxiety. The findings of this study can assist healthcare providers—including midwives and mental health counselors—in identifying pregnant women experiencing eco-anxiety and contribute to designing more precise mental health screening and supportive interventions to promote maternal mental health.
Ethical Considerations
Compliance with ethical guidelines
Written informed consent was obtained from all the participants. This study was conducted according to the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Qom University of Medical Sciences, Qom, Iran (Code: IR.MUQ.REC.1403.066).  
Funding
This study was funded by Qom University of Medical Sciences.
Authors contributions
Study design and conceptualization: Zahra Alipour; Data collection and writing: Sepideh Taghavi; Data analysis: Mohammad Aghaei; Editing & review: Zahra Alipour and Nahid Mehran; Final approval: All authors.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgments
The authors would like to thank the participants and the staff of comprehensive health centers in Qom for their cooperation in this research.