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A Level Geography Case Studies: contemporary examples

Give strength to your answers with case studies.

Case Studies are an important part of A Level Geography, as they help to exemplify your answers and show your application of geographical theory into real-world examples. Expand your knowledge and examples with Study Geography.

Why should I use A Level Geography Case Studies?

Exemplify your answers.

Utilising contemporary examples in an essay demonstrates thorough knowledge and gets higher marks.

Kept up-to-date

A recent development or occurrence will make its way onto our up-to-date learning platform.

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You can download our case studies as PDF, so you can add them to your notes and folders.

If you’re an A Level Geography student, you know how important it is to have a deep understanding of natural and human events in order to unlock higher marks. That’s where our A Level Geography case studies come in – providing you with the in-depth insights and examples that help you develop your answers.

Our A Level Geography case studies cover a wide range of topics, from coasts to changing places, and are designed to help you develop a clear understanding of examples of geography in action. We provide detailed analysis, key facts, and applications to theory to help you deepen your understanding and retain critical information.

Plus, with our easy-to-navigate platform, you can access all of our case studies whenever and wherever you need them, whether you’re studying at home or on-the-go. They’re available within our Course resources, and can be easily found within their respective topics.

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A Level Geography: Case Studies and Exam Tips

A-Level Geography is a challenging and rewarding subject that explores the dynamic relationships between people and their environments. The curriculum often includes the study of case studies to illustrate key concepts and geographical theories. In this article, we'll delve into the importance of case studies in A-Level Geography and provide exam tips to help you excel in this subject.

 The Significance of Case Studies in A-Level Geography

Case studies are essential in A-Level Geography for several reasons:

1. Illustrating Concepts: 

Case studies provide real-world examples that illustrate the geographical concepts and theories covered in the curriculum. They make abstract ideas tangible and relatable.

2. Application of Knowledge: 

Case studies offer opportunities for students to apply their geographical knowledge and analytical skills to specific situations. This application enhances understanding.

3. Contextual Learning: 

Case studies allow students to explore the complex and dynamic interactions between people and their environments in specific contexts. This contextual understanding is at the heart of geography.

4. Exam Requirement: 

In A-Level Geography exams, you are often required to use case studies to support your arguments and analysis. Having a repertoire of case studies at your disposal is crucial for success.

 Selecting and Using Case Studies

Here's how to select and effectively use case studies in your A-Level Geography studies and exams:

1. Diverse Selection: 

Choose a range of case studies that cover different geographical contexts, themes, and issues. This diversity will prepare you for various exam questions.

2. Local and Global: 

Include both local and global case studies. Local examples may provide opportunities for fieldwork, while global case studies allow you to explore international perspectives.

3. Relevance to the Curriculum: 

Ensure that your case studies align with the topics and themes covered in your A-Level Geography course. They should be relevant to your exam syllabus.

4. In-Depth Understanding: 

Study your selected case studies in-depth. Familiarize yourself with the geographical context, key facts, statistics, and relevant theories and concepts.

5. Interdisciplinary Approach: 

Recognize that geography often intersects with other subjects like environmental science, economics, and sociology. Explore how these interdisciplinary aspects come into play in your case studies.

6. Regular Review: 

Periodically review and update your case studies to ensure you have the most recent data and information. Geography is a dynamic field, and changes can occur over time.

 Exam Tips for A-Level Geography

Here are some tips to help you succeed in your A-Level Geography exams:

1. Practice Essay Writing: 

Geography exams often require essay-style responses. Practice writing coherent and well-structured essays that incorporate case studies effectively.

2. Master Map Skills: 

Geography exams may include map interpretation and analysis. Develop your map-reading skills to excel in this section.

3. Use Case Studies Wisely: 

When using case studies in your exam, ensure they are relevant to the question and directly support your argument. Avoid including irrelevant details.

4. Time Management: 

Manage your time wisely during the exam. Allocate specific time slots for each section or question and stick to the schedule.

5. Understand Command Terms: 

Be familiar with the command terms used in geography questions, such as "explain," "discuss," and "evaluate." Tailor your responses accordingly.

6. Practice Past Papers: 

Work through past exam papers to get a sense of the format and types of questions that may appear in your A-Level Geography exams.

7. Seek Feedback: 

If possible, ask your teacher or a peer to review your practice essays and provide feedback. Constructive feedback can help you refine your writing and analysis skills.

8. Stay Informed: 

Keep up with current geographical events and developments. This knowledge can be invaluable in your essays and discussions.

 Conclusion

A-Level Geography is a subject that bridges the gap between the natural and social sciences, offering a comprehensive view of the world. Case studies are pivotal in this field, providing practical examples that support your learning and exam performance. By selecting diverse and relevant case studies, studying them thoroughly, and practicing effective essay writing and map skills, you can navigate A-Level Geography with confidence and success.

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A* ALL (Physical and Human) A-Level Geography Case Studies

Subject: Geography

Age range: 16+

Resource type: Other

Last updated

10 May 2023

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Made for AQA A-level Geography (7037) Summarises ALL the case studies needed for the AQA A-level Exams PDF and Powerpoint Formats

I achieved an A* in the A-Level Exams using this resource.

Case studies for:

Carbon and Water Cycles

• River Exe Drainage Basin
• Amazon Rainforest
• Water Abstraction in the London Basin

Coastal Systems and Landscapes

• Holderness Coast
• Sundarbans (Bangladesh) Coast
• The Netherlands Coastal Management
• Morecambe Hard Engineering
• Sefton Soft Engineering
• Haiti Multi Hazard (Earthquake and Tropical Storms)
• Tohoku (Japan) Earthquake and Tsunami
• Indian Ocean Tsunami
• Eyjafjallajökull Volcano
• Nevado Del Ruiz Volcano
• Hurricane Katrina
• Typhoon Haiyan
• Australia 2019 Wildfire
• Alberta Canada Wildfire

Global Systems and Governance

• Banana Trade

Changing Places

• Belfast Reimaging and Rebranding
• Medellin Colombia Rebranding
• Portland Road (Notting Hill) Gentrification
• Detroit Place Study (Far/ Contrasting Place Study) [Does NOT include Near Place Study due to the subjective nature]

Population and the Environment

• Bangladesh Population
• Japan Population
• Windrush Migration
• £10 Poms, UK to Australia Migration
• East Europe to UK Migration
• Knowsley, Merseyside Health
• Glasgow Health
• Communicable Disease: Malaria
• Non Communicable Disease: Asthma
• Polar Tundra Climate
• Tropical Monsoon climate
• Tropical Red Latosol Soil
• Podsol Soil

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Not quite what you were looking for? Search by keyword to find the right resource:

• 3.1A What is Globalisation?
• 3.1B Transport Technology and Globalisation
• 3.1C Communication Technology
• 3.2A International Organisations
• 3.2B National Governments
• 2C SEZs and Attitudes to FDI
• 3A Measuring the Degree of Globalisation
• 3B Role of TNCs
• 3C Switched Off Locations
• 3.4A Benefits and Costs of Global Shift
• 4B Environmental Problems
• 4C Deinstrialisation and its Problems
• 5A Rural-Urban Migration and Megacities
• 5B International Migration
• 5C Costs and Benefits of Migration
• 6A Cultural Diffusion
• 6B Cultural Erosion
• 6C Opposition to Globalisation
• 7A Economic and Social Measures
• 7B Trends, Winners and Losers
• 7C Economic Development and Environmental Impact
• 8A Racial Tensions
• 8B Controlling the Spread of Globlisation
• 8C Attempts to Retain Cultural Identity
• 9A Local Sourcing
• 9B Fair Trade and Ethical Consumption
• 9C Recycling
• 4A.1A Classifying Economic Activity
• 4A.1B Economic Activity and Social Factors
• 4A.1C Quality of Life Indices
• 4A.1A Changing Function and Characteristics
• 4A.2B Reasons for the Change
• 4B.2C Measuring Change
• 3A Regional and National Influences
• 3B International and Global Influences
• 3C Identity
• 4A Successful Regions
• 4B Less Successful Regions
• 4C Priorities for Regeneration
• 5A Engagement
• 5B Lived Experience
• 5C Conflicts
• 6B Media Representation
• 6C Representation and Need for Regeneration
• 7A Infrastructure Investment
• 7B Planning Policies and Stuff
• 7C Negative Effects of Governmet Policys
• 8A Sympathetic Business Environments
• 8B Partnerships
• 8C Regeneration Strategies
• 9A Re-imaging
• 9B Rebranding Deinstrialised Places
• 9C Rebranding Rural Areas
• 10A Measuring the Success of Regeneration
• 10B Success and Social Progress
• 10C Improving Living Environments
• 11A Successful or Not?
• 12A Restructuring and Contested Decisions
• Scarborough and High Wycombe
• 7.1A Defining characteristics of powers
• 7.1B Hard and Soft Power Spectrum
• 7.1C Changing Importance of 7A and 7B
• 7.2A Imperial Era
• 7.2B Indirect Control
• 7.2C Geopolitical Stability and Risk
• 7.3A The Emerging Powers
• 7.3B Strengths and Weaknesses
• 7.3C Development Theory
• 7.4A - Influence through IGOs
• 7.4C Cultural Influence
• 7.5A Global Action
• 7.5B Alliances
• 7.5C the United Nations
• 7.6A Resource Demands
• 7.6B Environmental Governance
• 7.6C Middle-Class Consumption on Emerging Powers
• 7.7A Tension over Physical Resources
• 7.7B Intellectual Property
• 7.7C Political Spheres of Influence
• 7.8A Emerging Powers and the Developing World
• 7.8B Asian Tensions
• 7.8C Middle East Tensions
• 7.9A Economic Problems
• 7.9B Costs of Being a Superpower
• 7.9C Future Power Balance
• 8.1A GDP and Human Development
• 8.1B Best Development Goals?
• 8.1C Education
• 8.2A Variations in the Developing World
• 8.2B Variations in the Developed World
• 8.2C: Variations within Countries
• 8.3A The relationship between economic and social development
• 8.3B IGOs and Development
• 8.3C MDGs and SDGs
• 8.4A the UDHR
• 8.4B the ECHR
• 8.4C The Geneva Convention
• 8.5A Human Rights Vs Economic Development
• 8.5B Democratic Freedom
• 8.5C Political Corruption
• 8.6A Gender and Ethnic Differences
• 8.6B Health and Education Variations
• 8.6C Demands for Equality
• 8.7A Types of Interventions
• 8.7B Governments, IGOs and NGOs
• 8.7C Intervention and Sovereignty
• 8.8A About Development Aid
• 8.8B Does Aid Work?
• 8.8C Negatives of Economic Development
• 8.9A Military Interventions
• 8.9B Military Aid
• 8.9C Direct Military Intervention
• 8.10A Variables for Measuring Success
• 8.10B Democracy as 'Success'
• 8.10C - Economic Growth as Success
• 8.11A Successes and Failures
• 8.11B Aid and Equality
• 8.11C Aid as Foreign Policy
• 8.12A Costs of Recent Interventions
• 8.12B Non-Military may be Better?
• 8.12C - Consequences of Inaction
• 1.1A Distribution and Causes
• 1.1B Distribution of Boundaries
• 1.1C Intra-Plate Stuff
• 1.2A and B Plate Tectonics
• 1.2C Impacts on Hazards
• 3A Hazards from Earthquakes
• 3B Hazards from Volcanoes
• 1..3C - Tsunami
• 1.4A Definitions
• 1.4B The PAR Model
• 1.4C Impacts of Tectonic Hazards
• 1.5A Measuring Magnitude and Intensity
• 1.5B Hazard Profiles
• 1.5C Profile Examples
• 1.6A Inequality
• 1.6B Governance and Geographical Factors
• 1.6C Disaster Context
• 1.7A Trends since 1960
• 1.7B Megadisasters
• 1.7C Multiple Hazard Zones
• 1.8A - Prediction and Forecasting
• 1.8B The Hazard Management Cycle
• 1.8C Park's Model
• 1.9A Disaster Modification
• 1.9B Modifying Vulnerability
• 1.9C Modifying Loss
• 2B.1A Parts of the Littoral Zone
• 2B.1B Classifying Coasts
• 2B.1C Rocky Coasts and Coastal Plains
• 2B.2A Concordant and Discordant
• 2B.2B Their Morphology
• 2B.2C Geological Structure and Cliff Profiles
• 2B.3A Lithology
• 2B.3B Rock Strata and Complex Cliff Profiles
• 3C Vegetation Stabilisation of Sediment
• 4A Waves and Beach Morphology
• 4B Wave Erosion Processes
• 4C Coastal Landscapes Produced by Erosion
• 5A Sediment Transportation
• 5B Depositional Landforms
• 5C The Sediment Cell Model
• 6A Weathering
• 6B Mass Movement
• 6C Landforms Produced by Mass Movement
• 7A Long-Term Sea Level Change
• 7B Emergent and Submergent Coastlines
• 7C Contemporary Sea Level Change
• 8A Human Activity and Coastal Recession
• 8B Subaerial Processes Work Together
• 8C Temporal Variations in Coastal Recession
• 9A Local Factors that Increase Coastal Flood Risk
• 9B Storm Surges
• 9C Climate Change and Coastal Flood Risk
• A - Economic and Social Losses from Recession
• B - Flooding and Storm Surges
• C - Environmental Refugees
• 2.11A Hard Engineering
• 2.11B Soft Engineering
• 2.11C Sustainable Management
• 2B.12A Littoral Cells
• 2B.12B Policy Decisions
• 2B.2C Conflicts
• 1A - A Closed System
• 1B Importance and Size of Stores and Fluxes
• 1C The Global Water Budget
• 2A - the Hydrological Cycle
• 2B Impact of Physical Factors
• 2C - Impact of Human Factors
• 3.1 Water Budgets
• 3B River Regimes
• 3C Storm Hydrographs
• 4A - The Causes of Drought
• 4B - Human Activity and Drought
• 4C - Drought and Ecosystems
• 5A - Meteorological Causes of Flooding
• 5B - Human Activity and Flooding
• 5C - Impacts of Flooding
• 6A - Inputs and Outputs
• 6B - Stores and Flows
• 6C - Uncertainty
• 7A - Supply and Demand Mismatch
• 7B - Causes of Water Insecurity
• 7C - Finite Resources and Rising Demand
• 8A - Causes and Pattern of Physical and Economic Scarcity
• 8B - Importance of Water Supplies
• 8C - Conflicts
• 9A - Hard Engineering
• 5.9B Sustainable Water Management
• 5.9C Integrated Drainage Basin Management
• 1A Stores and Fluxes
• 1B Formation of Geological Carbon Stores
• 6.1C - Geological Processes Releasing Carbon
• 6.2A Oceanic Sequestering
• 6.2B Terrestrial Sequestering
• 6.2C Biological Carbon
• 6.3A Atmospheric Carbon
• 6.3B Maintaining a Balanced Carbon Cycle
• 6.3C Fossil Fuel Combustion
• 6.4A The Energy Mix
• 6.4B - Energy Consumption
• 6.4C Energy Players
• 6.5A Mismatch between Supply and Demand
• 6.5B Energy Pathways
• 6.5C Unconventional Fossil Fuels
• 6.6A Renewable and Recyclable Energy
• 6.6B Biofuels
• 6.6C Radical Technologies to Reduce Carbon Emissions
• 6.7A Growing Resource Demands
• 6.7B Ocean Acidification
• 6.7C Forest Health
• 6.8A Forest Loss
• 6.8B Rising Temperatures
• 6.8C Declining Ocean Health
• 6.9A Uncertainty about the Future
• 9.B Adaptation Strategies
• 6.9C Mitigation Strategies
• List of Case Studies

Human Geography ​

Globalisation, regenerating places, superpowers, health, human rights and interventions, ​ ​physical geography ​, tectonic process and hazards, coastal landscapes and change.

• Milankovitch cycles: 100,000 year cycle -> 90,000 years glacials (cold, + ice), 10,000 interglacial (warm, -ice)
• Rocky coasts - 1,000 km of the UK's coastline, mainly in the north and west
• 427m Conachair Cliff on the Isle of Hirta in the Isle of Hebrides   
• 3m cliffs Chapel Porth Cornwall
• A concordant coastline with resistant Portland limestone forming a protective stratum parallel to the sea. Behind it are less resistant Purbeck limestone and Wealden clay, which eroded very quickly when the portland limestone goes (producing Lulworth Cove and Stair Hole). 
• Lateral widening of coves may produce a single bay, again parallel to the coastline, such as Bull's Head in St Oswald's Bay. 
• 80% of residents of the Seychelles live and work at the coast.
• The Maldives have an average height of 1.5 m above sea level, but its population of 400,000 is too large to be easily accommodated elsewhere. It's highest point is 2.3 m above sea level, and a 50 cm rise would flood 77% of it. 
• New Zealand courts grant residence to 75 Tuvalu citizens each year as rising sea levels decrease its land area. In 2014, the Alesana family were granted permanent residence as 'climate change refugees'
• Groynes cost £150-250 per metre
• Rip-rap costs £1300-6000 per metre
• Sea walls cost £3000-10,000 per metre
• Beach nourishment typically costs more than £2000 per metre,but ongoing costs are high
• Cliff regrading and drainage commonly costs £10,000 per metre
• Dune fencing costs £4-20 per metre
• Dune replanting costs about £10 per metre
• Integrated Coastal Zone Management dates from the 1992 Rio Earth Summit - manages the entire coastal zone, recognises the importance of the coastal zone to people's livelihoods, management must be sustainable. It's over the long term, involves all the stakeholders and uses 'adaptive management' - changing plans as threats change. Works on the concept of littoral cells. 
• DEFRA policies: No active intervention; Hold the line; Strategic (Managed) Realignment; Advance the Line
• Strategic Realignment - allowing to recede, but directing to certain areas
• Advance the line (seaward side)
• Happisburgh, North Norfolk - No active intervention (managed realignment in the longer term)
• To defend the whole village would have an impact on the wider coastal management plan. Happisburgh would end up as a promontory, blocking longshore drift and causing further erosion downdrift. 
• Costs of erosion: Grade 1 listed St Mary's Church and Grade 2 listed Manor House would be lost. £160,000 available to the Manor Caravan Park to assist in relocating to a new site. £2000 per resident - £40,000-£70,000. Social costs. 
• Benefits of protection: by 2105, 20-35 houses would be 'saved' from erosion with a combined value of £4-7 million. 45 hectares of farmland. Manor Caravan Park - local jobs.
• The cost of building sea defences is about £6 million, very close to the value of property saved and much higher than the compensation costs to residents. Context of whole SMP. 
• Carry out an environmental impact assessment. Identifies short and long term impacts. 
• Losers are the poorest, who lack a formal land title. No insurance so lose everything. 
• Blackwater Estuary, Essex
• An area of tidal salt marsh and low-lying farmland. 
• It's prone to flooding and coastal erosion -> so traditionally protected by flood embankments and revetments. Not sustainable to just continue building higher and higher coastal defences. 
• In 2000 Essex Wildlife Trust purchased Abbots Hall Farm on Blackwater Estuary. 
• A 4000 ha managed realignment scheme was created by breaching the sea wall in five places in 2002, allowing new salt marsh to form inland. 
• The owners of Abbots Hall farm received the market price for their farmland, water quality in the estuary improved because of the expansion of reed beds that filter water quality. Income from ecotourism and wildlife watching. Dunlin, redshank, bass and herring nurseries were enhanced.  

The Water Cycle

• 1385 million km cubed
• Only 2.5% of water is freshwater. Only 1% of freshwater is easily accessible freshwater. 96.9% of total water is found in the oceans. Rivers only hold 0.007% of total water - but are the main water source for humans. 
• Ocean<->atmosphere: evaporation: 400,000; precipitation: 370,000
• land<->atmosphere: evaporation: 60,000; precipitation 90,000
• ocean<->land: surface runoff: 30,000 
• Amazon: less humidity, less precipitation, more surface run off, infiltration, soil being fed into rivers. 
• Water budget: annual balance between inputs and outputs. National - amount of water available for human use. Local, available soil water. A drainage basin water budget is calculated as precipitation = discharge + evapotranspiration +/- change in storage. 
• European mountain rivers have a high water period when glaciers feeding them melt rapidly (July-August) e.g. the Rhone
• In oceanic areas of Europe, rainfall is evenly distributed throughout the year, but there is low run off in the summer due to high evaporation. Thames. 
• In tropical areas, evapotranspiration tends to be high and stable, but a peak in the summer. (Blue Nile)
• Snowmelt in early spring or summer in mountainaous areas, e.g. the Great Plains of the USA. River Durance.  
• River regime - annual discharge, measured in cumecs. 

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Detailed Case Studies for A Level Geography

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Geography AS Notes

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Case Studies

In order to get a decent mark in Geography you need to use case studies and examples in your answers. If you don’t include them, you can’t get high marks. Even if a question doesn’t ask for an example, throw one in your answer, just to be safe. For many landforms, you don’t need to name a specific example, just an area where you can find these landforms. For example, naming a specific pothole would be a bit silly, but naming an area where you can find them is quite sensible.

• Flooding in a MEDC (Boscastle 2004)
• Flooding in a LEDC (Bihar 2008)
• Hard engineering project (The Three Gorges Dam, China)
• Soft engineering project (Restoring the River Cole)
• Potholes: The Strid on the River Wharfe (Yorkshire, UK)
• Waterfall: Pecca Falls (Ingelton, Yorkshire)
• Braided Channel: The Tagliamento (Italy)
• Levees: Along the Mississippi River (USA)
• Oxbow Lake: Found throughout Cuckmere Haven (Sussex, UK)
• Bird’s Foot Delta: The Mississippi Delta (USA)
• Cuspate Delta: Niger Delta (Nigeria)
• Arcuate Delta: Nile Delta (Egypt)
• River Terraces: Along the River Isis 1 (Oxford, UK)
• An example of cliff collapse and the effects of the collapse on the people living there (Barton-on-Sea)
• Hard Engineering Project (New Brighton)
• Soft Engineering Project (Thursaston)
• An example of coastal flooding due to either sea level rise or a natural disaster (Tōhoku Tsunami, Japan)
• Headland & Bay: Swanage Bay (South East Dorset, UK)
• Wave Cut Notches & Platforms: Around Hilbre Island (North West England)
• Arches, Stacks, Stumps & Geos: Again, all around Hilbre Island (North West England)
• Spit: Spurn Head (East Yorkshire, UK)
• Bar: Slapton Ley (Devon, UK)
• Tombolo: Chesil Beach (Isle of Portland, UK)
• Halosere/Salt Marsh: Parkgate (Wirral, UK)
• Psammosere/Sand Dune: Formby Beach (Sefton, UK)
• Rias: Lim Bay (Croatia)
• Fjord: Geirangerfjord 2 (Norway)
• Dalmatian Coastline: Dalmatian Coast (Croatia)
• The River Isis is actually the Thames. ↩
• Trust me, very few of these are easy to spell. Magdalenafjord, Tysfjord , Hardangerfjord , Eyjafjörður . ↩

Case Study: How does Japan live with earthquakes?

Japan lies within one of the most tectonically active zones in the world. It experiences over 400 earthquakes every day. The majority of these are not felt by humans and are only detected by instruments. Japan has been hit by a number of high-intensity earthquakes in the past. Since 2000 there are have been 16000 fatalities as the result of tectonic activity.

Japan is located on the Pacific Ring of Fire, where the North American, Pacific, Eurasian and Philippine plates come together. Northern Japan is on top of the western tip of the North American plate. Southern Japan sits mostly above the Eurasian plate. This leads to the formation of volcanoes such as Mount Unzen and Mount Fuji. Movements along these plate boundaries also present the risk of tsunamis to the island nation. The Pacific Coastal zone, on the east coast of Japan, is particularly vulnerable as it is very densely populated.

The 2011 Japan Earthquake: Tōhoku

Japan experienced one of its largest seismic events on March 11 2011. A magnitude 9.0 earthquake occurred 70km off the coast of the northern island of Honshu where the Pacific and North American plate meet. It is the largest recorded earthquake to hit Japan and is in the top five in the world since records began in 1900. The earthquake lasted for six minutes.

A map to show the location of the 2011 Japan Earthquake

The earthquake had a significant impact on the area. The force of the megathrust earthquake caused the island of Honshu to move east 2.4m. Parts of the Japanese coastline dr[[ed by 60cm. The seabed close to the focus of the earthquake rose by 7m and moved westwards between 40-50m. In addition to this, the earthquake shifted the Earth 10-15cm on its axis.

The earthquake triggered a tsunami which reached heights of 40m when it reached the coast. The tsunami wave reached 10km inland in some places.

What were the social impacts of the Japanese earthquake in 2011?

The tsunami in 2011 claimed the lives of 15,853 people and injured 6023. The majority of the victims were over the age of 60 (66%). 90% of the deaths was caused by drowning. The remaining 10% died as the result of being crushed in buildings or being burnt. 3282 people were reported missing, presumed dead.

Disposing of dead bodies proved to be very challenging because of the destruction to crematoriums, morgues and the power infrastructure. As the result of this many bodies were buried in mass graves to reduce the risk of disease spreading.

Many people were displaced as the result of the tsunami. According to Save the Children 100,000 children were separated from their families. The main reason for this was that children were at school when the earthquake struck. In one elementary school, 74 of 108 students and 10 out of 13 staff lost their lives.

More than 333000 people had to live in temporary accommodation. National Police Agency of Japan figures shows almost 300,000 buildings were destroyed and a further one million damaged, either by the quake, tsunami or resulting fires. Almost 4,000 roads, 78 bridges and 29 railways were also affected. Reconstruction is still taking place today. Some communities have had to be relocated from their original settlements.

What were the economic impacts of the Japanese earthquake in 2011?

The estimated cost of the earthquake, including reconstruction, is £181 billion. Japanese authorities estimate 25 million tonnes of debris were generated in the three worst-affected prefectures (counties). This is significantly more than the amount of debris created during the 2010 Haiti earthquake. 47,700 buildings were destroyed and 143,300 were damaged. 230,000 vehicles were destroyed or damaged. Four ports were destroyed and a further 11 were affected in the northeast of Japan.

There was a significant impact on power supplies in Japan. 4.4 million households and businesses lost electricity. 11 nuclear reactors were shut down when the earthquake occurred. The Fukushima Daiichi nuclear power plant was decommissioned because all six of its reactors were severely damaged. Seawater disabled the plant’s cooling systems which caused the reactor cores to meltdown, leading to the release of radioactivity. Radioactive material continues to be released by the plant and vegetation and soil within the 30km evacuation zone is contaminated. Power cuts continued for several weeks after the earthquake and tsunami. Often, these lasted between 3-4 hours at a time. The earthquake also had a negative impact on the oil industry as two refineries were set on fire during the earthquake.

Transport was also negatively affected by the earthquake. Twenty-three train stations were swept away and others experienced damage. Many road bridges were damaged or destroyed.

Agriculture was affected as salt water contaminated soil and made it impossible to grow crops.

The stock market crashed and had a negative impact on companies such as Sony and Toyota as the cost of the earthquake was realised.  Production was reduced due to power cuts and assembly of goods, such as cars overseas, were affected by the disruption in the supply of parts from Japan.

What were the political impacts of the Japanese earthquake in 2011?

Government debt was increased when it injects billions of yen into the economy. This was at a time when the government were attempting to reduce the national debt.

Several years before the disaster warnings had been made about the poor defences that existed at nuclear power plants in the event of a tsunami. A number of executives at the Fukushima power plant resigned in the aftermath of the disaster. A movement against nuclear power, which Japan heavily relies on, developed following the tsunami.

The disaster at Fukushima added political weight in European countries were anti-nuclear bodies used the event to reinforce their arguments against nuclear power.

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Case Studies (Entire Linear Course) for AQA A-Level Geography

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This series of 12 case study collection covers all the following subject content for the AQA A Level Geography specification:

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Effect of high-risk pregnancy on prenatal stress level: a prospective case-control study

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• Published: 11 May 2024

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• Hülya Türkmen   ORCID: orcid.org/0000-0001-6187-9352 1 ,
• Bihter Akın   ORCID: orcid.org/0000-0002-3591-3630 2 &
• Yasemin Erkal Aksoy   ORCID: orcid.org/0000-0002-7453-1205 2  

The study aimed to determine the effects of high-risk pregnancy on prenatal stress levels. The study was conducted with a case-control design in Turkey in September-December 2019. The sample included pregnant women diagnosed with high-risk pregnancy and were at their 36th or later gestational weeks as the case group ( n  = 121) and healthy pregnant women as the control group ( n  = 245). The Antenatal Perceived Stress Inventory (APSI) and the Revised Prenatal Distress Questionnaire (NUPDQ-17 Item Version) were used to assess the stress levels of the participants in the study. It was determined that high-risk pregnancy was associated with higher rates of prenatal stress (APSI: p  < 0.001, effect size = 0.388; NUPDQ: p  = 0.002, effect size = 0.272) compared to the control group. The results of the linear regression analysis showed that high-risk pregnancy affected APSI (R 2  = 0.043, p  < 0.001) and NUPDQ (R 2  = 0.033, p  = 0.009) scores, but education levels, number of pregnancies, and number of abortions did not affect APSI and NUPDQ scores. According to the results of this study, high-risk pregnant women are in a risk group for stress. It is of great importance for the course of a pregnancy that healthcare professionals assess the stress levels of pregnant women in the high-risk pregnancy category and provide psychological support to pregnant women who have high stress levels or are hospitalized.

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Introduction

A high-risk pregnancy is a significant health problem that threatens the health of the pregnant woman, the health of her fetus, and ultimately the health of her newborn, increases the risk of morbidity and mortality, and has physiological, psychological, social, and economic aspects (Cincioğlu et al., 2020 ; Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ). Chronic diseases existing before pregnancy and problems that arise during pregnancy can make a pregnancy risky. Pregnant women with gestational diabetes mellitus, preeclampsia/eclampsia, potential threat of preterm labor, cervical insufficiency, premature rupture of membranes, vaginal bleeding, Rh incompatibility, intrauterine growth retardation, and infections are in the high-risk category (Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; ACOG, 2019 ; Soğukpınar et al., 2018 ; Üzar-Özçetin & Erkan, 2019 ; ACOG, 2018 ).

Approximately 10% of all pregnancies in the world are considered to be in the high-risk category (Cincioğlu et al., 2020 ; Gourounti et al., 2015a , b ; Göüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; Soğukpınar et al., 2018 ; Üzar-Özçetin & Erkan, 2019 ). According to Turkey Demographic and Health Survey (TNSA) 2018 data, 35% of pregnancies in Turkey are in the high-risk category (Hacettepe University Institute of Population Studies, 2019 ).

Good mental health during pregnancy is important for the health of both the pregnant woman and her fetus (Gümüşdaş et al., 2014 ). In a high-risk pregnancy, the normal outcome of the pregnancy and the birth of a healthy baby are threatened. These pregnant women have a variety of health needs that must be met. If these needs are not met, the mother may experience extreme stress and anxiety (Ölçer & Oskay, 2015 ). In the case of intense stress caused by the risks of pregnancy, the elevation of catecholamines such as cortisol and epinephrine may increase the possibility of pregnancy complications (e.g., preeclampsia) and adversely affect pregnancy outcomes (e.g., intrauterine growth retardation) (Atasever & Çelik, 2018 ; Cetin et al., 2017 ; Deshpande, 2016 ; Gözüyeşil & Düzgün, 2021 ; Riggin, 2020 ; Traylor et al., 2020 ; Yüksel et al., 2013 ). Moreover, newborns exposed to extreme stress during the intrauterine period may have permanent health problems later in their lives (Graignic-Philippe et al., 2014 ; MacKinnon et al., 2018 ; Van De Loo et al., 2016 ).

It is seen that distress in pregnancy has a high prevalence ranging between 11.9% and 63.5% in studies conducted in Turkey (Yüksel et al., 2013 ; Çapık et al., 2015 ; Gözüyeşil & Düzgün, 2021 ). It is very important that health professionals identify pregnant women at risk of stress to ensure a healthy pregnancy process and protect the fetus and newborn from the harmful effects of stress. This way, more careful monitoring of pregnant women at risk of stress can be ensured, and the negative consequences of stress can be prevented with appropriate interventions (Williamson et al., 2023 ; Atasever & Çelik, 2018 ; Pinar et al., 2022 ). It is reported in the international literature that mental problems such as anxiety and stress are more common in high-risk pregnancies than in healthy pregnancies (Byatt et al., 2014 ; Abedian et al., 2015 ; Gourounti et al., 2015a , b ). In Turkey, there are few studies examining the prenatal stress levels of high-risk pregnant women. However, in these studies, the prenatal stress levels of women with healthy and high-risk pregnancies were not compared, and only the stress levels of high-risk pregnancies were determined (Gözüyeşil & Düzgün, 2021 ; Üzar-Özçetin & Erkan, 2019 ). Current evidence indicates that studies describing the concept of prenatal stress in high-risk pregnancies with different diagnoses are needed to learn more about the complex aspects of prenatal stress and identify the sociodemographic and obstetric factors that may lead to high-risk pregnancies for early diagnosis (Pinar et al., 2022 ; Hung et al., 2021 ; Gözüyeşil & Düzgün, 2021 ; Mete et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ; Atasever & Çelik, 2018 ). For this reason, it is thought that this study will guide healthcare professionals who provide care for women with high-risk pregnancies about the services they will provide.

This study aims to prospectively determine the effects of high-risk pregnancies on prenatal stress levels compared to healthy pregnant women, using two different measurement instruments.

Materials and methods

Research questions.

Does high-risk pregnancy have an impact on prenatal stress?

What are the factors affecting the prenatal distress levels of women diagnosed with high-risk pregnancy?

Is there a difference in prenatal stress levels among different high-risk pregnancy diagnoses?

Design and settings

This case-control study was conducted to determine the difference between the stress levels of women with healthy and high-risk pregnancies. In other words, it was aimed to determine the suspected causal effect of high-risk pregnancy on prenatal stress levels. This case-control study was carried out between September and December 2019 at the Obstetrics and Gynecology Inpatient and Outpatient Clinics of Atatürk City Hospital in the Balıkesir province of Turkey. The case and control groups included women who were selected from the same hospital.

The hospital where the study was conducted hosted a total of 4,152 deliveries in 2018. Approximately 10% of all pregnancies are considered to be in the high-risk category (Sinaci et al., 2020 ). The sample size required to conduct the study was calculated as 134 high-risk pregnant women using the Epi Info StatCalc program based on an assumed population size of 4152, prevalence of 10%, margin of error of 5%, and in a 95% confidence interval. The study was completed with a total of 384 pregnant women, including 134 high-risk pregnant women and 250 healthy pregnant women, who accepted to participate in the study and filled out the consent form. However, the data of 13 pregnant women in the case group and 5 pregnant women in the control group were excluded from the study because they filled out the data collection forms incompletely. For the case group ( n  = 121), the post hoc power analysis (G*Power 3.1) revealed a medium effect size and a power of 0.421.

The inclusion criteria of the study were being in a gestational week further than 36 weeks, not having a psychiatric diagnosis, and being 18 years old or order. Pregnant women who were hospitalized in the Obstetrics and Gynecology Inpatient Clinic, were diagnosed with high-risk pregnancy by a physician, and met the inclusion criteria were included in the high-risk pregnancy group. In the control group, pregnant women who were healthy, were at or above their 36th gestational week, and visited the Outpatient Clinics were included. Women who wanted to leave the study or responded incompletely to the data collection forms were excluded. After those who met the inclusion criteria were included, no pregnant women withdrew from the study by their own accord. However, 18 pregnant women were excluded from the study because they filled out the forms incompletely.

High-risk pregnancies were defined as the presence of one or more of the following: pre-existing chronic diseases, preeclampsia, gestational diabetes mellitus (GDM), vaginal bleeding, placenta previa, threat of preterm labor, premature rupture of membranes, intrauterine growth retardation (IUGR), fetal anomaly/distress, multiple pregnancy, polyhydramnios/oligohydramnios, Rh incompatibility, and infectious diseases (Cincioğlu et al., 2020 ; Gözüyeşil & Düzgün, 2021 ; Sinaci et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ).

Data collection

A Personal Information Form, the Antenatal Perceived Stress Inventory, and the Prenatal Distress Questionnaire were administered to the participants. The participants were informed about the study, the purpose of the study was explained to them, and their written consent was obtained. The data collection forms were administered to the participants by the first author. The data were collected based on the self-reports of the participants. The data collection period was between September and December 2019. The interviews lasted about 15 min for each participant.

Personal information form

The form which was prepared by the researchers in line with the literature consisted of a total of 20 questions on some characteristics of the participants, including their sociodemographic characteristics and obstetric history (Gözüyeşil & Düzgün, 2021 ; Mete et al., 2020 ; Üzar-Özçetin & Erkan, 2019 ; Atasever & Çelik, 2018 ).

Antenatal perceived stress inventory (APSI)

The Turkish validity and reliability study of the inventory developed by Razurel et al. ( 2014 ) to assess perceived stress in the prenatal period was performed by Atasever and Çelik ( 2018 ). The inventory is applied to pregnant women at the 36th -39th gestational weeks. It is a 5-point Likert-type scale (very much = 5 points, much = 4 points, quite = 3 points, a little = 2 points, none = 1 point) and consists of 12 items and 3 dimensions. Its dimensions are Medical and Obstetric Risks/Fetal Health, Psychosocial Changes during Pregnancy, and Prospect of Childbirth. The minimum and maximum scores that can be obtained from the inventory are 12 and 60. High scores indicate high levels of stress perceived by pregnant women. In the study conducted by Atasever and Çelik, Cronbach’s alpha internal consistency coefficient for APSI was found to be 0.70, while this coefficient was found as 0.81 in this study.

Revised prenatal distress questionnaire ((NUPDQ)-17 Item Version)

The questionnaire developed by Yali and Lobel ( 1999 ) to determine the levels of stress experienced by women regarding pregnancy-related issues was revised by Lobel ( 2008 ). The Turkish validity and reliability study of the questionnaire was performed by Yüksel et al. ( 2011 ). The questionnaire is in the form of a 3-point Likert-type scale (very much = 2 points, a little = 1 point, none = 0 point) and consists of 17 items. The questionnaire is unidimensional. The minimum and maximum scores that can be obtained from the questionnaire are 0 and 34. High scores indicate that pregnant women have high levels of prenatal distress. Cronbach’s alpha internal consistency coefficient for NUPDQ was found to be 0.85 in the study performed by Yüksel et al., while it was found as 0.82 in this study.

Statistical analysis

Frequency, percentage, mean, and standard deviation values were used in the data analyses. Whether the data had normal distribution was tested using the Kolmogorov-Smirnov test. The Chi-squared test and independent-samples t-test methods were used to identify the differences between groups in terms of the sociodemographic and obstetric information of the participants. The Mann-Whitney U Test was used to determine the differences between the case and control groups in terms of their total APSI, APSI subscale, and total NUPDQ scores. The Type I error level was accepted as p  < 0.05. A Cohen’s d value of 0.20 is considered to indicate a small effect size, a value of 0.50 is considered to show a medium effect size, and a value of 0.80 or greater is interpreted as a large effect size (Özsoy & Özsoy, 2013 ). Since education, number of pregnancies, and number of miscarriages, which are thought to have an impact on stress levels, may be confounding factors, the linear regression analysis in this study was carried out to determine whether these factors or high-risk pregnancy affected the stress levels of the participants (Models 1 and 2). As a result of the Mann-Whitney U Test, a significant difference was found between high-risk pregnancies and healthy pregnancies in terms of “psychosocial changes during pregnancy” and “prospect of childbirth”. For this reason, APSI dimensions were collected in a single model, and a linear regression analysis was performed for the further analysis of the relationship between high-risk pregnancy and the APSI dimension scores of the participants (Model 3). The variable with the highest β coefficient was considered the relatively most significant independent variable. Multicollinearity was ignored in case of Tolerance > 0.20 and variance inflation factors (VIF) < 10. R 2 shows what percentage of the dependent variable is explained by the independent variables. According to Cohen, R 2 values of 0.0196, 0.1300, and 0.2600 are the lower thresholds for small, medium, and large effect sizes, respectively (Özsoy & Özsoy, 2013 ). One-Way MANOVA was also conducted to see whether there was a difference in stress levels during pregnancy between the case and control groups. The comparison of the stress levels of the participants in the case group based on their diagnoses was conducted with the Kruskal-Wallis test.

Ethical considerations

For the study to be carried out, approval was obtained from the Clinical Research Ethics Committee of the Faculty of Medicine of the University, and written permission was obtained from the institution where the study would be conducted (2019/123). The purpose of the study was explained to the pregnant women who agreed to participate, and they were informed that their identifying information would be kept confidential. The written consent of the participants was obtained with the Volunteer Information Form. The participants in both the case and control groups who were thought to need counseling were referred to a specialist for psychological support.

Table  1 shows the sociodemographic and obstetric characteristics of the participants. There was no significant difference between the women in the case and control groups in terms of age, whether they had an income-generating job, income status, place of residence, parity, number of living children, status of having a planned pregnancy, and smoking status ( p  > 0.05). It was determined that the participants in the case group had significantly lower education levels than those in the control group ( p  < 0.001). Moreover, the number of pregnancies ( p  = 0.036) and the number of abortions ( p  = 0.012) in the case group were found significantly higher than those in the control group. These results supported the hypothesis that some sociodemographic and obstetric characteristics of women are associated with high-risk pregnancies.

According to the Kolmogorov-Smirnov test results, the total APSI and NUPDQ scores of the participants were not normally distributed ( p  < 0.001). Table  2 shows the stress levels of the participants compared based on their scale scores. The total APSI ( p  < 0.001, Cohen’s d = 0.388) and total NUPDQ ( p  = 0.002, Cohen’s d = 0.272) scores of the participants in the case group were significantly higher than those of the participants in the control group. The APSI Psychosocial Changes during Pregnancy ( p  < 0.001, Cohen’s d = 0.473) and Prospect of Childbirth ( p  < 0.001, Cohen’s d = 0.314) dimension scores of the participants in the case group were also significantly higher than those of the participants in the control group. These results supported the hypothesis that prenatal stress levels are higher in high-risk pregnancies than in healthy pregnancies.

Table  3 shows the stress levels of the participants with different diagnoses in the case group. In terms of risky pregnancies, the most frequently observed diagnoses were the threat of preterm labor in 37.2% of the participants in the case group, vaginal bleeding/placenta previa in 20.7%, and gestational diabetes mellitus in 10.7%. No statistically significant correlation was found between the diagnoses of the participants in the case group and their total APSI or NUPDQ scores ( p  > 0.05). This result did not support the hypothesis that there is a difference in prenatal stress levels based on differences in high-risk pregnancy diagnoses.

In the linear regression analysis, Model 1 included APSI on education, gravidity, number of abortions, and high-risk pregnancy, and it was determined that there was a significant relationship between APSI and high-risk pregnancies, where the former explained 4.3% of the total variance in the latter (R 2  = 0.043) ( p  < 0.001). Model 2 included NUPDQ on education, gravidity, number of abortions, and high-risk pregnancy, and it was determined that there was a significant relationship between NUPDQ and high-risk pregnancies, where the former explained 3.3% of the total variance in the latter (R 2  = 0.033) ( p  = 0.009). Model 3 included APSI dimensions, and it was determined that there was a significant relationship between psychosocial changes during pregnancy and high-risk pregnancy, where the former explained 5.7% of the total variance in the latter ( R  = 0.057) ( p  < 0.001) (Table  4 ).

As a result of the MANOVA, it was determined that having a high-risk or a pregnancy was associated with significant differences in the combined set of dependent variables (APSI and NUPDQ total scores), F = 6.231, p  = 0.002, Wilk’s Lambda = 0.967. There were significant differences between the case and control groups in terms of their APSI psychosocial changes during pregnancy and prospect of childbirth dimension scores, F = 7.258, p  < 0.001, Pillai’s Trace = 0.057. (Table  5 ).

This study determined the stress levels of pregnant women with high-risk and healthy pregnancies. Stress experienced in high-risk pregnancies can have negative effects in terms of the pregnancy process and maternal and fetal health (Atasever & Çelik, 2018 ; Gözüyeşil & Düzgün, 2021 ; Riggin, 2020 ; Traylor et al., 2020 ; Yüksel et al., 2011 ). Therefore, it is thought that the results of this study will contribute to the literature.

It was determined in this study that the education levels of the high-risk pregnant women, who constituted the case group, were lower compared to the healthy pregnant women in the control group. Other studies in the literature have shown that risk factors in pregnancy are at higher rates in women with low educational levels (Annagür et al., 2014 ; Soğukpınar et al., 2018 ; Topalahmetoğlu et al., 2017 ; Türkmen, 2019 ). It is thought that as education levels increase, the knowledge levels of pregnant women about the management of risk factors in pregnancy increase, and these situations are intervened with in the early period. Moreover, high education levels can also prevent factors that may cause a high-risk pregnancy such as malnutrition, ill-advised exercise practices, and lack of antenatal care. For this reason, considering the results of our study, it is recommended that health professionals provide education to pregnant women with low education levels about prenatal care, proper nutrition, exercise, and antenatal follow-ups.

The numbers of pregnancies and abortions among the participants in the case group in this study were significantly higher compared to those in the control group. In the study by Orbay et al. ( 2017 ), the number of pregnancies among pregnant women with GDM was lower than the number of pregnancies among those without GDM. Cincioğlu et al. ( 2020 ) found the mean number of abortions among pregnant women with risky pregnancies to be 1.31 ± 0.71. As the number of pregnancies increases, the potential risks of pregnancy also increase. More frequent monitoring of pregnant women with a high number of abortions by health professionals and providing information about family planning methods to women with a high number of pregnancies will prevent high-risk pregnancies.

High-risk pregnancies consist of many obstetric pathologies including maternal chronic diseases. Every pathologic condition experienced during pregnancy can affect the women’s stress levels (Sinaci et al., 2020 ). In this study, two different scales were used to measure the stress levels of the participants, and the stress levels of the participants in the case group were found to be higher than the stress levels of those in the control group. Gözübebek and Düzgün (2021) stated that 63.5% of pregnant women diagnosed with risky pregnancies experienced distress. Üzar-Özçetin and Erkan ( 2019 ) reported high perceived stress levels in high-risk pregnant women. In their meta-analysis study, Amiri and Behnezhad ( 2019 ) revealed that diabetes during pregnancy was a risk factor for anxiety symptoms, and diabetes increased the risk of anxiety by up to 48%. Other studies in the literature have shown that high-risk pregnant women also have high anxiety levels (Byatt et al., 2014 ; Denis et al., 2012 ; Gourounti et al., 2015a , b ; McDonald et al., 2021 ; Orbay et al., 2017 ; Sinaci et al., 2020 ; Hung et al., 2021 ).

It was reported that low education levels, having a history of abortion, and a high number of pregnancies may cause prenatal stress (Atasever & Çelik, 2018 ). In this study, lower education levels and higher numbers of pregnancies and abortions were found in the case group than in the healthy control group. Since low education levels and high numbers of pregnancies and abortions were thought to be potential confounding factors in terms of prenatal stress, further analyses tests were performed, and it was determined that these factors did not affect stress levels to a significant extent. The research in this field may benefit from a more in-depth exploration of potential implications and confounding factors related to education.

In the studies performed by Üzar-Özçetin and Erkan ( 2019 ) and Yüksel et al. ( 2013 ), it was found that the stress levels of pregnant women who had experienced hospitalization due to any risk during pregnancy were high. It is considered that diagnosis methods, treatment methods, symptoms, complications, and their effects on the fetus for high-risk pregnancies cause great stress in pregnant women, and the fact that some pregnant women spend this process in the hospital increases their stress levels even further. For this reason, considering the results of our study, it is recommended that healthcare professionals inform the pregnant woman about her diagnosis and symptoms and explain each procedure to be performed, and that healthcare institutions provide more comfortable hospital rooms.

In this study, it was seen that the prenatal stress levels of the participants were high in terms of psychosocial changes during pregnancy. Intense stress can cause a sense of helplessness and hopelessness by depleting the energy of individuals, as well as negatively affecting their physical and mental health (Sharma & Rush, 2014 ). For this reason, healthcare professionals have an important role in the care of pregnant women with high-risk pregnancies. They should take an active role in the early diagnosis of at-risk pregnant women through qualified home visits and by initiating and continuing treatment. Advanced clinical guidelines and case management models should be developed for women having high-risk pregnancies.

In the study by Pinar et al. ( 2022 ), women with high-risk pregnancies were given training on stress management. After the training program, it was determined that 51.4% of the women in the intervention group and 75.7% in the control group experienced stress. Based on these results, it is recommended that healthcare professionals provide training, to ensure the active participation of the pregnant woman and her partner, on stress management to reduce the perceived stress, anxiety, and hopelessness levels of women in high-risk pregnancy cases. Additionally, these pregnant women should be provided with methods to cope with stress such as breathing exercises, relaxation exercises, appropriate physical exercises, visualization/yoga, massage therapy, music therapy, explanations about social support factors, and practices strengthening their spirituality (Ölçer & Oskay, 2015 ).

In this study, no significant difference was found in the prenatal stress levels of the participants in the case group based on their obstetric diagnoses of high-risk pregnancy. In the study by Byatt et al. ( 2014 ), no significant difference was identified between obstetric diagnoses in terms of anxiety levels in pregnant women. A high-risk pregnancy causes high stress levels in pregnant women due to similar diagnostic tests, treatment methods, hospitalization, complications, and fetal outcomes (Kent et al., 2015 ).

It is thought that high stress levels are not associated with obstetric diagnoses, and similar stress levels are experienced by all pregnant women aware of any risky situation during their pregnancies. Nevertheless, an increase in stress levels in risky pregnancies such as cases of preeclampsia may cause a further aggravation in the clinical status of women. Healthcare professionals should be aware of the higher stress levels of these pregnant women, they should help the pregnant woman express her feelings and thoughts by providing a reassuring communication environment, and plan appropriate consultancy, intervention, and care routines to help reduce their stress levels. These professionals can also coach high-risk pregnant women in terms of stress reduction and coping mechanisms. Pregnant women with high stress levels should be referred to a specialist for psychological support and therapy.

Strengths and limitations

The strength of this study was its prospective design with a control group. In this study, the use of two similar scales in terms of measuring the stress levels of pregnant women provided rigor and transparency compared to data obtained in previous studies. Since these scales were included in studies in Turkey only in the context of testing their validity and reliability in Turkish, it was decided to use them in the study as they measure stress levels in the prenatal period. A limitation of the study was that the pre-pregnancy stress levels of the participants, which would affect their present condition, were not measured in the study. Women with high stress levels before pregnancy have a higher risk of high-risk pregnancy. In other words, instead of high-risk pregnancy increasing stress levels, high stress levels may have affected the high-risk pregnancy statuses of the women. The results of the study also revealed a significant difference in education levels between the case and control groups. However, as a result of further analyses, it was determined that education did not affect prenatal stress levels.

In this study, it was determined that high-risk pregnancy affected prenatal stress. Moreover, it was found that the participants in the case group who had high-risk pregnancies had lower education levels and higher numbers of pregnancies and abortions compared to the participants in the control group with healthy pregnancies. This is why healthcare professionals are recommended to bear in mind that pregnant women with low education levels and a high number of pregnancies and abortions are at risk of high-risk pregnancies and monitor these pregnant women more frequently and carefully.

It is of great importance for the course of a pregnancy that healthcare professionals assess the stress levels of pregnant women in the high-risk pregnancy category, provide psychological support to pregnant women who have high stress levels or are hospitalized, offer them counseling and training opportunities (e.g., relaxation exercises, breathing exercises, practices strengthening their spirituality, music therapy), take appropriate precautions, and refer these pregnant women to specialists if needed. Moreover, since the stress levels of these pregnant women will increase even more during childbirth, alternative methods to reduce the fear of childbirth and childbirth pain should be explained.

It is recommended to organize educational programs such as trainings, seminars, and conferences on stress management during pregnancy for health professionals working in family health centers, community health centers, and gynecology departments.

Consequently, more studies with larger sample sizes are needed to compare diagnostic stress levels in high-risk pregnancies. In addition to prenatal stress and childbirth fear levels, future studies should also determine the stress levels of women before pregnancy for similar comparisons between high-risk and healthy pregnancies.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors express thanks to the mothers for participation in the study.

Open access funding provided by the Scientific and Technological Research Council of Türkiye (TÜBİTAK). No funding was received to conduct the study.

Open access funding provided by the Scientific and Technological Research Council of Türkiye (TÜBİTAK).

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Study conception and design: Hülya TÜRKMEN.  Data collection:  Hülya TÜRKMEN.  Data analysis and interpretation:  Hülya TÜRKMEN.  Drafting of the article:  Hülya TÜRKMEN, Bihter AKIN, Yasemin ERKAL AKSOY.  Critical revision of the article:  Hülya TÜRKMEN, Bihter AKIN, Yasemin ERKAL AKSOY.

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Türkmen, H., Akın, B. & Erkal Aksoy, Y. Effect of high-risk pregnancy on prenatal stress level: a prospective case-control study. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-05956-z

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Accepted : 28 March 2024

Published : 11 May 2024

DOI : https://doi.org/10.1007/s12144-024-05956-z

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