The results of the study showed that 32.7, 32.7, and 43.9% of the participants had depression, stress and anxiety symptoms, respectively, with varying degrees from mild to very severe. Based on the adjusted general linear model, variables of education level, spouse’s job and marital life satisfaction were the predictors of depressive symptoms. Variables of spouse’s education level, spouse’s support, marital life satisfaction and the number of pregnancies were the predictive factors of anxiety symptoms and the variables of spouse’s education level, household income sufficiency, spouse’s support and marital life satisfaction were the predictors of stress symptoms.
In the present study, 67.3% of women had normal depression and stress and 32.7% had varying degrees of depression and stress. In terms of anxiety, 56.1% of people were normal, and 43.9% suffered from varying degrees of anxiety during the pandemic of SARS-CoV-2 disease. In line with the present study, in Effati et al.  study on pregnant women and in a similar setting to the present study (Tabriz-Iran) (2018), more than half of women were normal in terms of depression, stress and anxiety and about 36, 32, and 27% of women experienced varying degrees of depression, stress, and anxiety symptoms, respectively. Comparing the two groups, women’s stress and depression symptoms levels were expected to be more severe during the coronavirus outbreak, while the severity of these problems was almost the same as when the coronavirus did not exist in the community. In this regard, it can be said that pregnant women, due to the importance of their fetus and its emotional attachment, may take care of themselves and follow the health advices of SARS-CoV-2 seriously. Therefore, they should have more peace of mind and confidence, followed by less stress, anxiety and depression.
During the COVID-19 pandemic, the results of Berthelot et al.,  study showed that pregnant women had higher levels of stress, anxiety, and depression compared to the pregnant women who were examined before the pandemic, which is inconsistent with the results of our study. A possible reason for this discrepancy may be the cultural and social differences between our setting and their study. Another study by Durankus et al., (2020)  found that more than one-third of pregnant women had symptoms of depression and anxiety during the COVID 19 pandemic, which is almost in line with the findings of our study.
In a case-control study by Lee et al., during the outbreak of SARS, the results of anxiety in women who were pregnant during the outbreak of SARS were only slightly higher than in women who were pregnant before the outbreak of SARS and the rate of depression did not differ significantly between the two groups . Perhaps the reason for not increasing or slightly increasing of the severity of anxiety, stress and depression symptoms during the outbreak of diseases such as SARS and COVID-19 is that the disease is new or not taken seriously by people in the first spread. Due to the newness of COVID-19 disease and the lack of a study in the field, it was not possible to interpret the results of the present study in pregnant women with similar conditions in other studies.
In the present study, there was a significant relationship between spouse’s level of education with depression, anxiety and stress symptoms. Women whose husbands had a non-university education were less likely to report depression, anxiety, and stress compared to those with a university degree. In a study by Salmalian et al.,  there was a significant association between spousal education and depression before and after childbirth, so that as the level of education was lower, depression was higher. In a study on the general population , the level of education had a reverse statistical relationship with the three variables of depression, anxiety and stress. As the level of education increased, depression, stress and anxiety were reduced. The results of both studies are inconsistent with the results of the present study. Education can open people’s eyes and make them understand the situation, and increase their reaction to the events, especially in critical situations such as the prevalence of COVID-19. While people with non-university education may not have an idea of the bad condition and be less sensitive to the crisis of the outbreak of the disease, or may even be unaware of the dimensions of the crisis and the depth of the tragedy. While people with university education are expected to have more accurate follow-up of the deterioration of the situation from various sources such as scientific journals, cyberspace, media, etc. In addition, this increases the severity of depression, stress and anxiety symptoms and this causes a high level of depression, stress and anxiety in them and those around them.
In our study, there was a significant relationship between spouse’s job and symptoms of depression, so that women whose husbands were shopkeepers had more symptoms of depression than those whose husbands were employees. Salmalian et al.  reported a significant relationship between spouse’s job and pre and postpartum depression. Depression was more common in women whose husbands had lower-paying jobs, which is consistent with our results.
In the present study, there was a significant relationship between marital life satisfaction with depression, anxiety and stress scores during COVID-19 prevalence. Depression, stress and anxiety scores were lower in women who were satisfied and very satisfied with their lives compared to those who were moderately satisfied. In their study, Bakhshi et al.  showed that with increasing severity of depression among men and women, their marital life satisfaction decreased. Odinka et al.  in their study of low-risk women in the postpartum period also found a significant association between the severity of depression and anxiety and marital life satisfaction. The results of both studies were consistent with the present study.
In our study, anxiety and stress scores were significantly higher in women with high levels of support from their spouses than in those with moderate levels of support. However, one study reported high anxiety and fear of childbirth in women who had poor support from their husbands or dissatisfaction with their husbands’ support . In addition, the results of a study showed that in 86% of pregnant women, the support of the husband during pregnancy has reduced their stress symptoms, and more than 90% of them have reported a sense of emotional security following the support of the husband . The results of both studies are inconsistent with the results of our study. One of the possible causes of this mismatch could be that due to the depth of emotional relationships, high dependence and attachment to the spouse, the fear of losing him, his falling ill with COVID-19 disease is greater among those supported by spouses, and this can increase their stress and anxiety. It is also possible that the stress and anxiety caused by the COVID-19 pandemic in the mother will be so great that simply the support of the spouse cannot play an effective role in reducing it.
In our study, anxiety scores were significantly lower in women who experienced their first and second pregnancies than in those in the third and more pregnancies. Dunkel Schetter et al.  showed a high level of pregnancy anxiety in women during their first delivery. In their study of pregnant women, Rezaee et al.  did not report a difference in the number of parities between anxious and non-anxious women. Perhaps the reason for the lower anxiety in low parity in the COVID-19 pandemic in this study is the high relationship of mothers with low parity with health centers, which helps to obtain sufficient and accurate information and reduce their anxiety.
According to available sources, this study is the first to investigate the depression, stress and anxiety of Iranian pregnant women and their predictive factors during the prevalence of COVID-19, and the random sampling of participants is another strength of the study.
One of the limitations of this study is the cross-sectional nature of it, the relationships shown between socio-demographic variables with symptoms of stress, depression and anxiety cannot accurately reflect the causal relationship. Another limitation was that those who could have a mobile phone with internet connection could participate in this study. Although 100% of the women studied had a cell phone, only 60% had a phone with this feature. Therefore, as a limitation, this study may not be the representative of pregnant women in Iran in general.
In addition, the low level of participation was another limitation, as about half of pregnant women completed the questionnaire online. Perhaps the reason for this is the recent online method of collecting data in Iran, where all previous projects with pregnant women have been done in person.