Effects of the COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study

Evaluation of psychological impact, depression, and anxiety among pregnant women during the COVID-19 pandemic in Lahore, Pakistan

Concerns about vulnerability to COVID‐19 and vertical transmission of the disease led to increased incidence of psychological distress, depression, anxiety, and sleep disturbance among pregnant women in Lahore, Pakistan.

A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective

Currently, the world is in the seventh month of the COVID-19 pandemic. Globally, infections with novel SARS-CoV-2 virus are continuously rising with mounting numbers of deaths. International and local public health responses, almost in synchrony, imposed restrictions to minimize spread of the virus, overload of health system capacity, and deficit of personal protective equipment (PPE). Although in most cases the symptoms are mild or absent, SARS-CoV-2 infection can lead to serious acute respiratory disease and multisystem failure. The research community responded to this new disease with a high level of transparency and data sharing; with the aim to better understand the origin, pathophysiology, epidemiology and clinical manifestations. The ultimate goal of this research is to develop vaccines for prevention, mitigation strategies, as well as potential therapeutics.The aim of this review is to summarize current knowledge regarding the novel SARS CoV-2, including its pathophysiology and epidemiology, as well as, what is known about the potential impact of COVID-19 on reproduction, fertility care, pregnancy and neonatal outcome. This summary also evaluates the effects of this pandemic on reproductive care and research, from Canadian perspective, and discusses future implications.In summary, reported data on pregnant women is limited, suggesting that COVID-19 symptoms and severity of the disease during pregnancy are similar to those in non-pregnant women, with pregnancy outcomes closely related to severity of maternal disease. Evidence of SARS-CoV-2 effects on gametes is limited. Human reproduction societies have issued guidelines for practice during COVID-19 pandemic that include implementation of mitigation practices and infection control protocols in fertility care units. In Canada, imposed restrictions at the beginning of the pandemic were successful in containing spread of the infection, allowing for eventual resumption of assisted reproductive treatments under new guidelines for practice. Canada dedicated funds to support COVID-19 research including a surveillance study to monitor outcomes of COVID-19 during pregnancy and assisted reproduction. Continuous evaluation of new evidence must be in place to carefully adjust recommendations on patient management during assisted reproductive technologies (ART) and in pregnancy.

Mental health of Urban Mothers (MUM) study: a multicentre randomised controlled trial, study protocol

INTRODUCTION

Mental health disorders are common during pregnancy and the postnatal period and can have serious adverse effects on women and their children. The consequences for global mental health due to COVID-19 are likely to be significant and may have a long-term impact on the global burden of disease. Besides physical vulnerability, pregnant women are at increased risk of mental health problems such as anxiety, depression and post-traumatic stress disorder due to the consequences of social distancing. It can result in altered healthcare routines, less support from the family and friends, and in some cases, partners not being allowed to be present during prenatal visits, labour and delivery. Higher than expected, rates of perinatal anxiety and depression have been already reported during the pandemic. Pregnant women may also feel insecure and worried about the effects of COVID-19 on their unborn child if they get infected during pregnancy. Today, young urban women are used to using internet services frequently and efficiently. Therefore, providing mental health support to pregnant women via internet may be effective in ameliorating their anxiety/depression, reducing the risk of serious mental health disorders, and lead to improved maternal and perinatal outcomes.

OVERARCHING AIM

Our aim is to explore the effectiveness of a web-based psychosocial peer-to-peer support intervention in reducing the risk and severity of perinatal mental health disorders and preventing adverse pregnancy outcomes among pregnant women living in metropolitan urban settings.

METHODS AND ANALYSIS

We plan to conduct a multicentre prospective randomised controlled trial, Mental health of Urban Mothers trial. Pregnant women living in large metropolitan cities will be recruited using internet-based application through non-profit organisations' websites. The women who consent will be randomised to receive a web-based peer-to-peer support intervention or usual care. Data will be analysed to identify the effects of intervention on Edinburgh Postnatal Depression Score and Generalised Anxiety Disorder 7 scores as well as pregnancy outcomes. The impact of COVID-19 pandemic on maternal stress will be assesed using Impact Event Scale-R. Any differences in outcomes between cities will be addressed in subgroup analyses.

ETHICS AND DISSEMINATION

The study will be conducted according to the principles of Good Clinical Practice and will follow the ethical principles of the Declaration of Helsinki. The study protocol has been approved by the ethical review board of Chinese University of Hong Kong (IRB number 2019-8170) and Shanghai Center for Women's and Children's Health (international review board (IRB) number 2020-F001-12). The results will be disseminated at national and international scientific conferences, published in peer-reviewed medical journals and spread to the public through social media, news outlets and podcasts.

TRIAL REGISTRATION NUMBER

NCT04363177; Trial sponsor Karolinska Institute, CLINTEC, Stockholm, Sweden.

The Medium-Term Impact of COVID-19 Lockdown on Referrals to Secondary Care Mental Health Services: A Controlled Interrupted Time Series Study

To date, there is a paucity of information regarding the effect of COVID-19 or lockdown on mental disorders. We aimed to quantify the medium-term impact of lockdown on referrals to secondary care mental health clinical services. We conducted a controlled interrupted time series study using data from Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), UK (catchment population ~0.86 million). The UK lockdown resulted in an instantaneous drop in mental health referrals but then a longer-term acceleration in the referral rate (by 1.21 referrals per day per day, 95% confidence interval [CI] 0.41-2.02). This acceleration was primarily for urgent or emergency referrals (acceleration 0.96, CI 0.39-1.54), including referrals to liaison psychiatry (0.68, CI 0.35-1.02) and mental health crisis teams (0.61, CI 0.20-1.02). The acceleration was significant for females (0.56, CI 0.04-1.08), males (0.64, CI 0.05-1.22), working-age adults (0.93, CI 0.42-1.43), people of White ethnicity (0.98, CI 0.32-1.65), those living alone (1.26, CI 0.52-2.00), and those who had pre-existing depression (0.78, CI 0.19-1.38), severe mental illness (0.67, CI 0.19-1.15), hypertension/cardiovascular/cerebrovascular disease (0.56, CI 0.24-0.89), personality disorders (0.32, CI 0.12-0.51), asthma/chronic obstructive pulmonary disease (0.28, CI 0.08-0.49), dyslipidemia (0.26, CI 0.04-0.47), anxiety (0.21, CI 0.08-0.34), substance misuse (0.21, CI 0.08-0.34), or reactions to severe stress (0.17, CI 0.01-0.32). No significant post-lockdown acceleration was observed for children/adolescents, older adults, people of ethnic minorities, married/cohabiting people, and those who had previous/pre-existing dementia, diabetes, cancer, eating disorder, a history of self-harm, or intellectual disability. This evidence may help service planning and policy-making, including preparation for any future lockdown in response to outbreaks.

Anxiety and depression symptoms in the same pregnant women before and during the COVID-19 pandemic

Objectives With clinical experience from previous coronavirus infections, public health measures and fear of infection may have negative psychological effects on pregnant women. This study aimed to compare the level of anxiety and depression in the same pregnant women before and during the COVID-19 pandemic. Methods The pregnant women continuing pregnancy who participated in the first study which was undertaken to clarify the factors associated with mental health of pregnant women before the COVID-19 pandemic, were included for the current study during the outbreak. Anxiety and depression symptoms of the same pregnant women were evaluated by using the Inventory of Depression and Anxiety Symptoms II and Beck Anxiety Inventory twice before and during the pandemic. Results A total of 63 pregnant women completed questionnaires. The mean age of the women and the mean gestational age was 30.35±5.27 years and 32.5±7 weeks, respectively. The mean total IDAS II score was found to increase from 184.78±49.67 (min: 109, max: 308) to 202.57±52.90 (min: 104, max: 329) before and during the SARS-CoV-2 pandemic. According to the BAI scores the number of patients without anxiety (from 10 to 6) and with mild anxiety (from 31 to 24) decreased and patients with moderate (from 20 to 25) and severe anxiety (from 2 to 8) increased after SARS-CoV-2 infection. Multivariate linear regression analysis revealed that obesity and relationship with her husband are the best predictors of IDAS II scores. Conclusions This study indicated that COVID-19 outbreak affects the mental health of pregnant women negatively which leads to adverse birth outcomes. The level of anxiety and depression symptoms of pregnant women during the COVID-19 infection significantly increased. Healthcare professionals should establish comprehensive treatment plans for pregnant women who are highly vulnerable population to prevent mental trauma during the infectious disease outbreaks.

The impact of the COVID-19 pandemic on the perinatal mental health of women

Objectives The physical health impact of the coronavirus disease infection (COVID-19) has received attention worldwide; however, data around the psychological impact of the pandemic is still emerging and little has been reported on psychological effects among vulnerable groups. This study was undertaken with the aim of studying the impact of the COVID-19 pandemic and related restrictions on perinatal mental health among women in Qatar. Methods A cross- sectional survey of women accessing maternity services in Qatar was carried out during the months of June and July 2020 at the local peak of the pandemic. Background data including relevant demographic details, pregnancy and mental health history, concerns, as well as helpful stress-reducing factors reported by women was collected. Depression and anxiety symptomatology was studied using the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS). Results The survey results revealed a high prevalence of anxiety and Depressive symptomatology (34.4 and 39.2% respectively), based on PHQ-ADS scoring. These rates appeared much higher than the reported pre-pandemic prevalence and were not affected by occupation, previous mental health problems or pregnancy complications. Women's most commonly reported concerns as well as coping factors are discussed. Conclusions Results indicate a marked increase in anxiety and depressive symptoms during the COVID-19 pandemic, among pregnant and puerperal individuals, who constitute a vulnerable group with respect to mental health morbidity. These findings can be used to inform public health interventions, among which, consideration should be given to routine mental health screening of vulnerable groups during major health crises.

The impact of the COVID-19 pandemic on depression and stress levels in pregnant women: a national survey during the COVID-19 pandemic in Mexico

BACKGROUND

COVID-19 outbreak has been associated with a wide variety of psychiatric manifestations such as panic, anxiety, and depression. We aim to assess the impact of the COVID - 19 pandemic on the levels of stress and depression of pregnant women in Mexico.

METHODS

A cross-sectional web survey was carried out in pregnant women in 10 states of the Mexican Republic during the COVID-19 pandemic among public and private hospitals. The perception of stress was assessed using the Perceived Stress Scale, while depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale.

RESULTS

A total of 549 surveys were applied, of which 96.1% (n = 503) were included in the data analysis. The mean participant's age was 28.1 years old. The mean perceived stress scale score was 24. 33.2% (n = 167) of participants had a score equal to 27 points or more and were considered highly stressed. The mean depression score was 9. A total of 17.5% (n = 88) participants had more than 14 points on the Edinburgh's depression scale, and were considered depressed. Stress levels were higher at later gestational ages (p = .008).

CONCLUSIONS

COVID-19 pandemic has caused mental health issues in pregnant women reflected by high perceived stress levels and depression.

Mental Health of Pregnant and Postpartum Women During the Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis

Background: Prenatal and postnatal mental disorders can exert severe adverse influences on mothers, fetuses, and children. However, the effect of the coronavirus disease 2019 (COVID-19) pandemic on the mental health of pregnant and postpartum women remains unclear. Methods: Relevant studies that were published from January 1, 2019 to September 19, 2020 were identified through the systematic search of the PubMed, EMBASE, and Web of Science databases. Quality assessment of included studies, random-effects meta-analysis, sensitivity analysis, and planned subgroup analysis were performed. Results: A total of 23 studies conducted with 20,569 participants during the COVID-19 pandemic and with 3,677 pregnant women before the COVID-19 pandemic were included. The prevalence rates of anxiety, depression, psychological distress, and insomnia among pregnant women during the COVID-19 pandemic were 37% (95% confidence interval [CI] 25-49%), 31% (95% CI 20-42%), 70% (95% CI 60-79%), and 49% (95% CI 46-52%), respectively. The prevalence of postpartum depression was 22% (95% CI 15-29%). Multigravida women and women in the first and third trimesters of pregnancy were more vulnerable than other pregnant women. The assessment of the associations between the COVID-19 pandemic and mental health problems revealed that the pooled relative risks of anxiety and depression in pregnant women were 1.65 (95% CI: 1.25-2.19) and 1.08 (95% CI: 0.80-1.46), respectively. Conclusions: The prevalence rates of mental disorders among pregnant and postpartum women during the COVID-19 pandemic were high. Timely and tailored interventions should be applied to mitigate mental problems among this population of women, especially multigravida women and women in the first and third trimesters of pregnancy.

An Integrated Approach to Improve Maternal Mental Health and Well-Being During the COVID-19 Crisis

The ongoing COVID-19 pandemic has led to disruption of normal life across the globe, severely affecting the already vulnerable populations such as the pregnant women. Maternal mental health and well-being is a public health priority and the evidence about the impact of COVID-19 on mental health status of pregnant women is gradually emerging. The findings of the recently published studies suggest that increased risk perception about contracting COVID-19, reduced social support, increase in domestic violence, disruption of antenatal care, and economic consequences of COVID-19 mitigation strategies can lead to adverse mental health outcomes in antenatal period. There is a significant increase in antenatal depression and anxiety since the onset of COVID-19 and social determinants of health (e.g., younger age, lower education, lower income) are associated with these poor outcomes. In this paper, we propose an integrated approach to improve the mental health and well-being of pregnant women. Physical activity and/or mind-body interventions like yoga can be practiced as self-care interventions by pregnant women. Despite social distancing being the current norm, efforts should be made to strengthen social support. Evidence-based interventions for perinatal depression should be integrated within the health system and stepped, collaborative care using non-specialist health workers as key human resource be utilized to improve access to mental health services. Use of digital platforms and smartphone enabled delivery of services has huge potential to further improve the access to care. Most importantly, the COVID-19 related policy guidelines should categorically include maternal mental health and well-being as a priority area.

Psychosocial factors associated with postpartum psychological distress during the Covid-19 pandemic: a cross-sectional study

BACKGROUND

Trauma, natural and man-made catastrophic events can be predictors of postpartum psychological distress. In a public health response due to coronavirus disease 2019 outbreak, the Italian government imposed a lockdown from March 9 to May 3. This extraordinary situation may have been challenging for maternal psychological health. The aim of this study was to investigate the prevalence of depressive and post-traumatic stress symptoms in women giving birth during the Covid-19 pandemic and its associations with quarantine measures, obstetrical factors, and relational attachment style.

METHODS

Women who gave birth in a high-volume obstetric/gynaecological medical centre located in an epidemic area during the Covid-19 pandemic (March 8 to June 15) were asked to complete an online survey about their childbirth experience and the perceived effect of the pandemic. The Edinburgh Postnatal Depression Scale (EPDS), the Impact of Event Scale-Revised (IES-R), and the Relationship Questionnaire (RQ) were administered to assess levels of postpartum depressive and post-traumatic stress symptoms (PTSS) and relational style of attachment, respectively. Multivariate analysis was applied to identify associations between quarantine measures, childbirth experience, attachment style, and EPDS and IES-R scores.

RESULTS

The survey was completed by 163 women (response rate 60.8%). The prevalence of depressive symptoms was 44.2% (EPDS cut-off score ≥ 11) and the PTSS rate was 42.9% (IES-R cut-off score ≥ 24). Dismissive and fearful avoidant attachment styles were significantly associated with the risk of depression and PTSS, respectively. Perceived pain during birth was a risk factor for postpartum depression. Perceived support provided by healthcare staff was a protective factor against depression and PTSS. Another protective factor against PTSS was quiet on the ward due to the absence of hospital visitors.

CONCLUSION

This study reports a high prevalence of postpartum depressive and PTSS in women who gave birth during the Covid-19 pandemic. Postnatal psychological distress seemed to be associated more with the prenatal experience and other individual factors than with the pandemic hospital restrictions. Early detection during pregnancy of an insecure attachment style is fundamental to provide targeted preventive and therapeutic psychological interventions.

Attitudes and precaution practices towards COVID-19 among pregnant women in Singapore: a cross-sectional survey

Background

COVID-19 may predispose pregnant women to higher risks of severe disease and poorer neonatal outcome. Psychological sequalae of this pandemic may pose a greater conundrum than its clinical aspects. It is currently unknown that how pregnant women cope with this global pandemic and its ramifications. The aims of the study are to understand the attitudes and precaution practices of non-infected pregnant women towards the COVID-19 outbreak in Singapore.

Methods

An online cross-sectional survey of COVID-19 awareness among pregnant women attending antenatal clinics in Singapore was conducted. An internet link was provided to complete an online electronic survey on Google platform using a quick response (QR) code on mobile devices. The online survey consists of 34 questions that were categorized into 4 main sections, namely 1) social demographics 2) attitude on safe distancing measures 3) precaution practices and 4) perceptions of COVID-19. Multiple linear regression analysis was performed to examine women’s precaution practices among six independent socio-demographic variables, including age, ethnicity, education, front-line jobs, history of miscarriage and type of antenatal clinic (general, high risk).

Results

A total of 167 survey responses were obtained over 8 weeks from April to June 2020. The majority of women were aged ≤35 years (76%, n = 127), were of Chinese ethnicity (55%, n = 91), attained tertiary education (62%, n = 104) and were not working as frontline staff (70%). Using multiple linear regression models, Malay ethnicity (vs. Chinese, β 0.24; 95% CI 0.04, 0.44) was associated with higher frequency of practicing social distancing. Malay women (β 0.48; 95% CI 0.16, 0.80) and those who worked as frontline staff (β 0.28; 95% CI 0.01, 0.56) sanitized their hands at higher frequencies. Age of ≥36 years (vs. ≤30 years, β 0.24; 95% CI 0.01, 0.46), Malay (vs. Chinese, β 0.27; 95% CI 0.06, 0.48) and Indian ethnicity (vs. Chinese, β 0.41; 95% CI 0.02, 0.80), and attendance at high-risk clinic (vs. general clinic, β 0.20; 95% CI 0.01, 0.39) were associated with higher frequency of staying-at-home.

Conclusion

Social demographical factors including age > 36 years old, Malay ethnicity, employment in front line jobs and attendance at high-risk clinics are likely to influence the attitudes and precaution practices among pregnant women towards COVID-19 in Singapore. Knowledge gained from our cross-sectional online survey can better guide clinicians to communicate better with pregnant women. Hence, it is important for clinicians to render appropriate counselling and focused clarification on the effect of COVID-19 among pregnant women for psychological support and mental well being.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03378-w.

COVID-19 pandemic and maternal mental health: a systematic review and meta-analysis

OBJECTIVE

To evaluate the effect of the COVID-19 pandemic on anxiety and depression of women during pregnancy and perinatal period.

METHODS

We systematically searched online databases to identify any report on maternal depression during pregnancy or postpartum using the Edinburgh Postnatal Depression Survey (EPDS) and maternal anxiety using the State-Trait Anxiety Inventory (STAI) until 5th July 2020. The random-effects model was used to pool the effect sizes and standardized mean differences (SMDs) and the corresponding 95% confidence intervals (CIs).

RESULTS

Eight studies reported depressive and anxiety states of 7750 women, either pregnant or postpartum were included. The overall pooled EPDS score was higher among women during pandemic (SMD= 0.40, 95% CI: -0.05 - 0.86, p = .083) compared to previous non-pandemic times, without reaching a statistically significant difference. However, the overall pooled STAI score was significantly higher during pandemic (SMD= 0.82, 95% CI: 0.49 - 1.16, p < .001). No significant publication bias existed in selected studies (p > .05).

CONCLUSION

The present meta-analysis provides evidence that the COVID-19 pandemic significantly increases the risk of anxiety among women during pregnancy and perinatal period. Support measures should be considered for women during pregnancy or perinatal period to guarantee mental health for this susceptible population.

Does having a high-risk pregnancy influence anxiety level during the COVID-19 pandemic?

Objective

We aimed to analyze the changing level of anxiety during COVID-19 pandemic in pregnant women, with and without high-risk indicators separately, in a tertiary care center serving also for COVID-19 patients, in the capital of Turkey.

Study design

We designed a case-control and cross-sectional study using surveys. The Spielberger State-Trait Anxiety Scale questionnaire (STAI-T) and Beck Anxiety Inventory (BAI) which were validated in Turkish were given to outpatient women with high-risk pregnancies as study group and normal pregnancies as control group. A total of 446 women were recruited.

Results

There was a statistically significant difference between those with and without high-risk pregnancy in terms of Trait-State Anxiety scores with COVID-19 pandemic (p < 0.05). We found an increased prevalence of anxiety during COVID-19 pandemic in high-risk pregnant women comparing to pregnancies with no risk factors (p < 0.05). There was a statistically significant difference between the education level in high-risk pregnant women in terms of anxiety scores (p < 0.05), Beck Anxiety score was highest in high school graduates (42.75). While the level of Trait Anxiety was the highest with pandemic in those with high-risk pregnancy with threatened preterm labor and preterm ruptures of membranes (58.0), those with thrombophilia were the lowest (50.88).

The State Anxiety level and Beck Anxiety Score of those with maternal systemic disease were the highest (53.32 and 45.53), while those with thrombophilia were the lowest (46.96 and 40.08).

The scores of Trait Anxiety (56.38), State Anxiety (52.14), Beck Anxiety (43.94) were statistically higher during the pandemic in those hospitalized at least once (p < 0.05).

Conclusion

High-risk pregnant women require routine anxiety and depression screening and psychosocial support during the COVID-19 pandemic. High-risk pregnancy patients have comorbid conditions most of the time, hence they not only at more risk for getting infected, but also have higher anxiety scores because of the stress caused by COVID-19 pandemic.

COVID-19 Significantly Affects Maternal Health: A Rapid-Response Investigation from Pakistan

The coronavirus disease 2019 (COVID-19) is still unfolding. Its several implications are visible, yet more of them we have to observe and witness in future. Dealing with these impacts, this rapid-response article aims to situate the COVID-19 pandemic within Pakistan's overall sociocultural and politico-economic context; next to investigate the impacts of COVID-19 particularly the psychological ones on pregnant women in Pakistan via five case. One case history of Haleema (pseudonym) revealed how the pandemic exerted a substantial amount of mental pressure due to “arranging someone to accompany her to the hospital, finding a blood donor for her, and insecurity of convenience to hospital.” In this article, we show that Pakistan's geographical division into urban with an appropriate healthcare system, infrastructure and economic status, and more impoverished rural areas may show different impacts on people in general and the pregnant women in particular. This difference of facilities may contribute to disease transmission in the more deprived areas, that also due to cultural norms and mores such as shaking hands, cheek-kissing, and hugging that spread the virus are being overturned and that pregnant women are particularly vulnerable to psychological effects of the pandemic.

Spiritual Health and Stress in Pregnant Women During the Covid-19 Pandemic

Stress is one of the effective factors in the occurrence of negative effects during pregnancy that can cause adverse outcomes such as preterm delivery and reduced intrauterine growth of the fetus in pregnant women. Therefore, one of the serious concerns during the COVID-19 pandemic is the physical health and mental health of pregnant women. This study aimed to evaluate the physical health status with the spiritual and mental health of pregnant women during the COVID-19 pandemic. The study is a descriptive study in 2019-2020 and the samples were randomly selected from all pregnant women who referred to hospitals and private maternity centers before and during the COVID-19 pandemic and performed all pregnancy and fetal health tests. It was performed on 560 pregnant female samples. The mental status of pregnant women was assessed using the DASS Spiritual Health and Stress Questionnaire. Data analysis was performed using SPSS statistical software (version 24). The results of this study showed that preterm birth, height, weight, and head circumference of babies and lungs and respiratory status of children with mental health and stress levels of pregnant women during the corona are significant compared with the previous of corona (p < 0.05). Increasing stress and decreasing the mental health of pregnant women during COVID-19 pandemic can increase the influencing factors in preterm delivery and unhealthy birth.

Depression, stress, anxiety and their predictors in Iranian pregnant women during the outbreak of COVID-19

Background

Pregnancy as a sensitive period of a woman’s life can be affected by various psychological factors that can have adverse effects on the woman, her fetus and future baby. Since COVID-19 is a new phenomenon with limited information available, it may have adverse psychological effects on pregnant women. Therefore, this study was conducted to determine the status of depression, stress, anxiety and their predictors in Iranian pregnant women during the outbreak of COVID-19.

Methods

This descriptive-analytical cross-sectional study was performed on 205 pregnant women covered by Tabriz health centers in Iran. The sampling method used was cluster sampling. The data collection tool was the socio-demographic characteristics questionnaire and the DASS-21 (Depression, Anxiety and Stress Scale-21), which were completed online by pregnant women. The general linear model was used to determine the predictive factors of depression, anxiety and stress.

Results

The mean (SD) score of depression, stress, and anxiety were 3.91 (3.9), 6.22 (4.25), and 3.79 (3.39), respectively; the score range of 0 to 21. Depression, stress, and anxiety symptoms were observed in 32.7, 32.7, and 43.9% of the participants, 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 predictors of stress symptoms.

Conclusions

Considering the role of marital life satisfaction, high level of spouse’s education and income in reducing symptoms of stress, anxiety, and depression in pregnant women in critical situations such as the prevalence of COVID-19, it seems that using strategies to promote marital life satisfaction and socio-economic status can play an effective role in controlling anxiety and reducing stress and depression in pregnant women.

Perinatal Distress During COVID-19: Thematic Analysis of an Online Parenting Forum

Background

The COVID-19 global pandemic has impacted the whole of society, requiring rapid implementation of individual-, population-, and system-level public health responses to contain and reduce the spread of infection. Women in the perinatal period (pregnant, birthing, and postpartum) have unique and timely needs for directives on health, safety, and risk aversion during periods of isolation and physical distancing for themselves, their child or children, and other family members. In addition, they are a vulnerable group at increased risk of psychological distress that may be exacerbated in the context of social support deprivation and a high-risk external environment.

Objective

The aim of this study is to examine the public discourse of a perinatal cohort to understand unmet health information and support needs, and the impacts on mothering identity and social dynamics in the context of COVID-19.

Methods

A leading Australian online support forum for women pre- through to postbirth was used to interrogate all posts related to COVID-19 from January 27 to May 12, 2020, inclusive. Key search terms included “COVID,” “corona,” and “pandemic.” A three-phase analysis was conducted, including thematic analysis, sentiment analysis, and word frequency calculations.

Results

The search yielded 960 posts, of which 831 were included in our analysis. The qualitative thematic analysis demonstrated reasonable understanding, interpretation, and application of relevant restrictions in place, with five emerging themes identified. These were (1) heightened distress related to a high-risk external environment; (2) despair and anticipatory grief due to deprivation of social and family support, and bonding rituals; (3) altered family and support relationships; (4) guilt-tampered happiness; and (5) family future postponed. Sentiment analysis revealed that the content was predominantly negative (very negative: n=537 and moderately negative: n=443 compared to very positive: n=236 and moderately positive: n=340). Negative words were frequently used in the 831 posts with associated derivatives including “worried” (n=165, 19.9%), “risk” (n=143, 17.2%), “anxiety” (n=98, 11.8%), “concerns” (n=74, 8.8%), and “stress” (n=69, 8.3%).

Conclusions

Women in the perinatal period are uniquely impacted by the current pandemic. General information on COVID-19 safe behaviors did not meet the particular needs of this cohort. The lack of nuanced and timely information may exacerbate the risk of psychological and psychosocial distress in this vulnerable, high-risk group. State and federal public health departments need to provide a central repository of information that is targeted, consistent, accessible, timely, and reassuring. Compensatory social and emotional support should be considered, using alternative measures to mitigate the risk of mental health disorders in this cohort.

Effect of COVID-19 pandemic process on prenatal diagnostic procedures

OBJECTIVE

To evaluate the accessibility of pregnant women to prenatal screening and diagnostic tests during the COVID-19 pandemic process and analyze the effect of the pandemic process on acceptance-rejection rates of fetal diagnostic procedures for high risk pregnancies.

MATERIALS AND METHODS

As part of this cross-sectional study, during the pandemic, between the dates of 11 March 2020-30 June 2020 at Karadeniz Technical University Faculty of Medicine Perinatology Clinic, fetal structural anomaly detected by ultrasonography or with increased risk in screening test in the first and second trimester of high risk pregnancies, who were therefore recommended a prenatal diagnosis test, were defined as the control group and retrospectively compared with high risk pregnancies of the same periods (11 March 2019-30 June 2019) in the previous year.

RESULTS

A total of 267 cases were evaluated within the scope of the study. The rate of pregnant women undergoing the first and second trimester screening tests was 83% in the control group and 56% for pregnant women in the study group. When the total number of prenatal diagnostic procedures and the year each of the procedures performed are compared, a statistically significant difference was found between the study and control groups (p: .041 and p < .001, respectively). When evaluating the rates of performed prenatal diagnostic procedures during the first patient visit in comparison to years, a statistically significant difference was observed in the A/S group and in the total number of cases (p = .023, p < .001, respectively). Similarly, the rate of performed prenatal diagnostic procedure during the first patient visit and the patient's city of residence was similarly statistically significant from year to year (p < .05).

CONCLUSIONS

The decrease in number of prenatal diagnosis and screening tests during the COVID-19 pandemic draws attention. Prenatal care services are a serious issue that cannot be overcome by any deficiencies in both maternal and fetal care.

The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis

The coronavirus disease 2019 (COVID-19) pandemic has caused enormous psychological impact worldwide. We conducted a systematic review and meta-analysis on the psychological and mental impact of COVID-19 among healthcare workers, the general population, and patients with higher COVID-19 risk published between 1 Nov 2019 to 25 May 2020. We conducted literature research using Embase, PubMed, Google scholar and WHO COVID-19 databases. Among the initial search of 9207 studies, 62 studies with 162,639 participants from 17 countries were included in the review. The pooled prevalence of anxiety and depression was 33% (95% confidence interval: 28%-38%) and 28% (23%-32%), respectively. The prevalence of anxiety and depression was the highest among patients with pre-existing conditions and COVID-19 infection (56% [39%-73%] and 55% [48%-62%]), and it was similar between healthcare workers and the general public. Studies from China, Italy, Turkey, Spain and Iran reported higher-than-pooled prevalence among healthcare workers and the general public. Common risk factors included being women, being nurses, having lower socioeconomic status, having high risks of contracting COVID-19, and social isolation. Protective factors included having sufficient medical resources, up-to-date and accurate information, and taking precautionary measures. In conclusion, psychological interventions targeting high-risk populations with heavy psychological distress are in urgent need.

Online Antenatal Care During the COVID-19 Pandemic: Opportunities and Challenges

People across the world have been greatly affected by the ongoing coronavirus disease (COVID-19) pandemic. The high infection risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in hospitals is particularly problematic for recently delivered mothers and currently pregnant women who require professional antenatal care. Online antenatal care would be a preferable alternative for these women since it can provide pregnancy-related information and remote clinic consultations. In addition, online antenatal care may help to provide relatively economical medical services and diminish health care inequality due to its convenience and cost-effectiveness, especially in developing countries or regions. However, some pregnant women will doubt the reliability of such online information. Therefore, it is important to ensure the quality and safety of online services and establish a stable, mutual trust between the pregnant women, the obstetric care providers and the technology vis-a-vis the online programs. Here, we report how the COVID-19 pandemic brings not only opportunities for the development and popularization of online antenatal care programs but also challenges.

Mental Health Outcomes in Perinatal Women During the Remission Phase of COVID-19 in China

BACKGROUND

Since the middle of March, the COVID-19 outbreak has been well contained in China. The prevention and control measures for the outbreak have been downgraded to a normalized level. However, until now, the change in level of psychological health amongst perinatal women during the remission phase of the COVID-19 outbreak has not been investigated in China. The aim of this current study was to assess the symptoms of anxiety, depression, insomnia and quality of life (QOL) in perinatal women and to identify potential risk factors associated with these symptoms.

METHODS

This was a cross-sectional, hospital-based survey conducted between March 25^th till June 5^th, 2020 in southern China. Convenient sampling method was adopted. Women's anxiety, depression, insomnia symptoms and QOL was examined through standardized measurements. Multivariate logistic regression and Analysis of Covariance (ANCOVA) was conducted for the same.

RESULTS

A total of 625 perinatal women completed the study; of them, 195 women (31.2%, 95%CI=27.56%-34.84%) reported anxiety, 120 (19.2%, 95%CI=16.10%-22.30%) reported depression, and 87 (13.9%, 95%CI=11.20%-16.64%) experienced symptoms of insomnia. Previous adverse experiences during pregnancy was a significant risk factor for anxiety (OR=1.628, 95%CI=1.069-2.480, P=0.023), depression (OR=1.853, 95%CI=1.153-2.977, P=0.011), and insomnia (OR=2.160, 95%CI=1.290-3.616, P=0.003). Participants having infected friends/families/colleagues were more likely to report anxiety (OR=2.195, 95%CI=1.245-3.871, P=0.007) and depression (OR=2.666, 95%CI=1.482-4.794, P=0.001). Those women whose regular check-ups were severely interrupted by the COVID-19 were also more likely to experience symptoms of anxiety (OR=2.935, 95%CI=1.701-5.062, P<0.001) and insomnia (OR=2.195, 95%CI=1.098-4.390, P=0.026).

CONCLUSION

The COVID-19 pandemic does affect the mental health and well being of perinatal women. Increased attention should be paid to women who have infected friends/families/colleagues and those with previous adverse experiences during pregnancy. Coping strategies that relieve psychological stress during the COVID-19 outbreak should be provided to prevent adverse outcomes for women and their infants.