Evaluating depression and anxiety throughout pregnancy and after birth: impact of the COVID-19 pandemic

Effectiveness of Internet-Based Emotion-Focused Cognitive Behavioral Therapy (iECBT) with and without husband's participation in improvement of psychological distress in pregnant women with anxiety disorders: a randomized controlled trial

BACKGROUND

Anxiety disorders are common psychological pregnancy problems that can lead to adverse pregnancy outcomes. The study aimed to compare the improvement of psychological distress between Internet-Based Emotion-Focused Cognitive Behavioral Therapy (iECBT) with and without husbands' participation in pregnant women with anxiety disorders.

METHOD

In a randomized controlled trial, 84 pregnant women diagnosed with anxiety disorders were randomly assigned to two groups: iECBT alone (n = 42) and iECBT with their husband's participation (n = 42). In a group of iECBT alone, women received eight sessions of iECBT (with a duration of 50 min) once a week. In the iECBT group with the husband's participation, women received psychotherapy as same as iECBT alone, and their husbands received eight sessions (with a duration of 20 min) once a week. The outcomes were the Spielberger State-Trait Anxiety Inventory (STAI), the Brief Symptom Inventory 18, the pregnancy-specific stress, and Garnefski's cognitive emotion regulation in the four-time series.

RESULTS

The mean age of participants was about 30 years. Both iECBTs, with and without the husband's participation, were effective in improving state anxiety, psychological distress, pregnancy-specific stress, and emotion regulation in pregnant women. iECBTs with and without the husband's participation were not superior to each other regarding improving the outcomes.

CONCLUSION

As iECBT with the husband's participation was not superior to iECBT alone, further studies should evaluate proper strategies to increase men's effective role in the treatment of their pregnant partners with psychological disorders.

TRIAL REGISTRATION

IRCT20110228005931N10.

Unveiling the Mental Health of Postpartum Women During and After COVID-19: Analysis of Two Population-Based National Maternity Surveys in Romania (2020-2025)

(1) Background: The COVID-19 pandemic caused widespread upheaval, presenting unique challenges for pregnant and postpartum women, who were already in a particularly vulnerable phase. As the COVID-19 pandemic and its public health response unfolded, it became crucial for clinicians and researchers to explore postpartum depression within the context of a global crisis. (2) Methods: We used data from two cross-sectional surveys of postnatal women conducted in our tertiary academic public hospital during the SARS-CoV-2 pandemic and the post-pandemic period, based on the retrospective assessments of two samples of mothers, each including 860 postpartum women. Our research has been conducted with the scope of evaluating postpartum depression disorder during and after the COVID-19 pandemic by using comparable data across time. (3) Results: The prevalence of postpartum depression was significantly higher among women who gave birth during the COVID-19 pandemic (major postpartum depressive disorder: 54.19%, minor depressive disorder: 15.58%), compared to pre-pandemic rates (10% in developed countries and 21-26% in developing countries) and post-pandemic rates (major depressive disorder 10.12%, minor depressive disorder 10.93%). The results of our research indicate that the COVID-19 pandemic had a major negative impact on perinatal mental health and, moreover, might have sped up an existing trend of the increasing prevalence of postpartum depression, despite the fact that the risk factors for postpartum depression disease remained consistent before, during, and after the pandemic. (4) Conclusions: Strengthening support systems during periods of heightened risk, such as during a pandemic, is crucial; therefore, policymakers and health planners should prioritize the mental health of this vulnerable group during global health crises or natural disasters, ensuring the implementation of effective mental health screenings, identification, enhanced support, follow-up, and reassurance measures to better address the challenges faced by susceptible postpartum women in future similar situations.

Anxiety Assessment Using the Visual Analogue Scale Among Women Undergoing Elective Cesarean Section

Introduction Patients scheduled to undergo surgery are likely to experience anxiety. Furthermore, anxiety levels are significantly higher in obstetric patients compared to the general population. The most common operation performed on obstetric patients is a cesarean section. The purpose of our study is to evaluate pregnant women's anxiety prior to an elective cesarean section. Method A prospective study was conducted on a sample of hospitalized pregnant women scheduled for elective cesarean section in a Greek secondary hospital from October 2023 to March 2024. An anonymous questionnaire was administered 12-15 hours before delivery. The first part of the questionnaire included demographic data and closed-ended questions regarding educational level, parity, type of anesthesia in a previous cesarean section, and the presence of pathology in the current pregnancy. The second part consisted of the Visual Analogue Scale (VAS) for anxiety assessment. A total of 50 pregnant women participated in this study with a mean age of 30.5 years old (SD=6.1). Results  The average anxiety score was 6.14 with a standard deviation of 2.52. From the relationships examined, it emerged that higher VAS values are expected for younger women (r=-0.344; p=0.014). Additionally, significantly higher values were recorded for nulliparous women (M=7.54; SD=2.5) compared to multiparous women (M=5.65; SD=2.37) according to the independent samples t-test (t=-2.437; p=0.019). From the same analysis, significantly higher values were observed for pregnant women exhibiting pregnancy-related pathologies (M=7.60; SD=1.43) compared to women undergoing a smoothly progressing, uncomplicated pregnancy (M=5.78; SD=2.61) (t=-2.117; p=0.039). Finally, there was no statistically significant difference between the level of education or the type of anesthesia in a previous cesarean section and the VAS. Conclusion Anxiety prior to an elective cesarean section is expected to be greater in younger women and in nulliparous, while it is also higher for women with pregnancy-related pathologies. Participating in antenatal classes, creating a birth plan, and receiving professional support from health providers are examples of effective strategies to reduce anxiety, even before an elective cesarean section.

Exploring Maternal Challenges: A Pilot Study of Pain, Fatigue, and Anxiety in Newborn Care Within Rooming-in Settings

Background: In the rooming-in system, mothers and their healthy newborns stay together for 24 h a day; however, many women in the early postpartum period often find it challenging to balance their recovery from childbirth with the demands of caring for their newborns. This study aims to investigate the need for postpartum women to entrust their newborns to medical staff for care, and the relationship of this need with perceived pain, fatigue, and anxiety. Methods: The study uses the Need to Entrust a Newborn under the Care of the Staff (NEN) scale and the Numerical Rating Scale (NRS) to assess participants' levels of pain, fatigue and anxiety. These scales were chosen to provide a comprehensive assessment of participants' needs and experiences. Results: The results of the study reveal that fatigue levels among study participants were significantly high, with an Me of 7.0 (IQR = 4.0), exceeding the reportable levels of both pain (Me = 6.0, IQR = 5.0) and anxiety (Me = 5.0, IQR = 6.0) The need for support during the day and at night was at a similar level and strongly correlated (rho = 0.723; p < 0.001). Pain levels showed a significant positive correlation with the need to entrust the newborn both during the day (rho = 0.296; p < 0.001) and at night (rho = 0.332; p < 0.001). During the daytime, the correlation of fatigue with the need for staff support was rho = 0.423 (p < 0.001), while overnight, this increased to rho = 0.485 (p < 0.001). Anxiety significantly correlated with the need for staff support, both during daytime (rho = 0.422; p < 0.001) and overnight (rho = 0.431; p < 0.001). Multiparas reported significantly lower results of anxiety (U(Z) = -13.224, p < 0.001). Conclusions: The need to entrust newborns to the care of maternity rooming-in staff is strong but is often unmet in many facilities. Further research should be conducted to explore solutions, and plan future actions to alleviate the burdens on postpartum women and facilitate their recovery.

Changes associated with the COVID-19 pandemic on postpartum screening results in Ontario, Canada: The healthy babies healthy children screening tool

BACKGROUND

Research on the impact of the COVID-19 pandemic on mothers/childbearing parents has mainly been cross-sectional and focused on psychological symptoms. This study examined the impact on function using ongoing, systematic screening of a representative Ontario sample.

METHODS

An interrupted time series analysis of repeated cross-sectional data from a province-wide screening program using the Healthy Babies Healthy Children (HBHC) tool assessed changes associated with the pandemic at the time of postpartum discharge from hospital. Postal codes were used to link to neighborhood-level data. The ability to parent or care for the baby/child and other psychosocial and behavioral outcomes were assessed.

RESULTS

The co-primary outcomes of inability to parent or care for the baby/child were infrequently observed in the pre-pandemic (March 9, 2019-March 15, 2020) and initial pandemic periods (March 16, 2020-March 23, 2021) (parent 209/63,006 (0.33%)-177/56,117 (0.32%), care 537/62,955 (0.85%)-324/56,086 (0.58%)). Changes after pandemic onset were not observed for either outcome although a significant (p = 0.02) increase in slope was observed for inability to parent (with questionable clinical significance). For secondary outcomes, worsening was only seen for reported complications during labor/delivery. Significant improvements were observed in the likelihood of being unable to identify a support person to assist with care, need of newcomer support, and concerns about money over time.

CONCLUSIONS

There were no substantive changes in concerns about ability to parent or care for children. Adverse impacts of the pandemic may have been mitigated by accommodations for remote work and social safety net policies.

Early childhood psychopathology and parental mental health during the COVID-19 pandemic: the effects of pandemic restrictions on 0- to 3-year-olds

Introduction

The COVID-19 pandemic placed many restrictions on families and affected the mental health of parents and children. The present study examines how the restrictions imposed during the pandemic and parental mental health affect early childhood psychopathology.

Method

From September 2019 to December 2021, the Outpatient Department of Family Therapy at the Institute for Psychosocial Prevention, Heidelberg surveyed a clinical sample of 249 families who sought consultation for early childhood psychopathology. Early childhood psychopathology in children aged 0-3 years was assessed using the German Questionnaire for Crying, Feeding and Sleeping and the German version of the Child Behavior Checklist 1½-5. The Patient Health Questionnaire provided information on parental depressiveness and generalized anxiety. At the same time, the Stringency Index as part of the Oxford Coronavirus Government Response Tracker indicated the severity of COVID restrictions in Germany.

Results

Dependent comparisons did not reveal significant differences in the infants' regulatory problems (n = 165, mean age = 8 months) during the lockdown compared to reopening phases. However, older children (n = 84, mean age = 25 months) exhibited more behavioral problems during lockdowns compared to reopening phases (Cohen's d = 0.32, p = .04). Subsequent regression analyses confirmed a slight increase in behavioral problems only among children aged 1.5-3 years (p = .047, R 2 = .08), but did not indicate any increase in parental mental health problems when more restrictions were in place. However, parental depressiveness had a strong independent effect on early childhood psychopathology. A hierarchical regression analysis indicated that psychopathology in children aged 1.5-3 years is best explained by female child gender, high parental depressiveness, and more severe restrictions during the COVID-19 pandemic (p < .001, R 2 = .17) whereas early childhood psychopathology in infants aged 0-1.5 years is more prevalent in younger and male children with parents experiencing higher levels of depressiveness (p < .001, R 2 = .26).

Discussion

The study found no increase in infant regulatory disorders or parental depressiveness and generalized anxiety during the pandemic. However, older children exhibited more behavioral problems during more severe pandemic restrictions. The study supports the provision of parent-child support during crises and beyond, as early childhood psychopathology was strongly associated with parental depressiveness.

New perinatal mental health conditions diagnosed during COVID-19: a population-based, retrospective cohort study of birthing people in Ontario

PURPOSE

We aimed to determine the incidence of mental health diagnoses and associated health and social risk factors among perinatal people in three different COVID-19 phases.

METHODS

We conducted a population-based, retrospective cohort study using linked administrative datasets. We included persons with live, in-hospital births in Ontario, Canada from January 1 to March 31 in 2019, 2021, or 2022 (three phases relative to COVID-19 with different public health policy measures). We excluded people with prior mental health diagnoses. We used diagnostic codes to identify new onset of depression, anxiety, or adjustment disorder in the antenatal and postpartum period. We developed multivariable, modified Poisson models to examine associations between sociodemographic and clinical factors and new mental health diagnoses in each phase.

RESULTS

There were 72,242 people in our cohort. Antenatal mental health diagnoses were significantly higher in 2021 (aRR = 1.32; CI = 1.20-1.46) and 2022 (aRR = 1.22; CI = 1.11-1.35) versus 2019. Postpartum diagnoses were significantly greater in 2021 (aRR = 1.16; CI = 1.08-1.25) versus 2019. Antenatal diagnoses were associated with birth year, previous stillbirth, pre-existing hypertension, multiparity, residential instability, and ethnocultural diversity. Postpartum diagnoses were associated with birth year, maternal age, multiparity, care provider profession, assisted reproductive technology, birthing mode, pre-existing hypertension, intensive care admission, hospital readmission, residential instability, and ethnocultural diversity. Family physicians increasingly made mental health diagnoses in 2021 and 2022.

CONCLUSION

Increased incidence of perinatal mental health diagnoses during COVID-19 suggests complex dynamics involving pandemic and health and social risk factors.

REGISTRATION

This study was registered with Clinicaltrials.gov (NCT05663762) on December 21, 2022.

Factors associated with COVID-19 infection in pregnant women: Focusing on maternal anxiety

OBJECTIVE

Given the critical importance of maternal mental health for the well-being of both the mother and fetus, it is essential to thoroughly investigate the impact of COVID-19 infection on mental health. This study aims to identify the factors associated with COVID-19 infection and mental health, underscoring the necessity of effective mental health management for pregnant women.

METHODS

Data were analyzed from 97 pregnant women who visited Gachon University Gil hospital in South Korea. Coronavirus 2019 (COVID-19) infection status was categorized based on whether the infection occurred during pregnancy. Maternal anxiety, the dependent variable, was measured using the state anxiety scale of the Spielberger State-Trait Anxiety Inventory. Multiple logistic regression analysis was performed to examine the association between COVID-19 infection and anxiety.

RESULTS

Among the 97 pregnant women, 50 (51.5%) experienced anxiety. Of those infected with COVID-19, 31 (64.6%) experienced anxiety. The mean anxiety score was significantly higher in pregnant women with COVID-19 infection compared to those without infection (Infected: Mean = 46.35, SD = 13.85; Non-infected: Mean = 39.59, SD = 10.58, p-value:0.008). Maternal depression, and posttraumatic stress disorder were significantly higher in pregnant women with COVID-19 infection, while fetal attachment showed no significant difference. Pregnant women infected with COVID-19 during pregnancy were more likely to experience anxiety compared to non-infected women (Adjusted OR = 9.37; 95% CI = 1.39-63.12).

CONCLUSION

This study highlights that pregnant women infected with COVID-19 are more likely to experience elevated levels of anxiety, emphasizing the critical importance of addressing mental health among pregnant women. The insights from this study could provide valuable guidance for policymaking, underscoring the need for targeted interventions to manage mental health in pregnant women and mitigate the risk of adverse outcomes.

Societal costs of untreated perinatal mood and anxiety disorders in Vermont

PURPOSE

To estimate the societal costs of untreated perinatal mood and anxiety disorders (PMADs) in Vermont for the 2018-2020 average annual birth cohort from conception through five years postpartum.

METHODS

We developed a cost analysis model to calculate the excess cases of outcomes attributed to PMADs in the state of Vermont. Then, we modeled the associated costs of each outcome incurred by birthing parents and their children, projected five years for birthing parents who do not achieve remission by the end of the first year postpartum.

RESULTS

We estimated that the total societal cost of untreated PMADs in Vermont could reach $48 million for an annual birth cohort from conception to five years postpartum, amounting to $35,910 in excess societal costs per birthing parent with an untreated PMAD and their child.

CONCLUSION

Our model provides evidence of the high costs of untreated PMADs for birthing parents and their children in Vermont. Our estimates for Vermont are slightly higher but comparable to national estimates, which are $35,500 per birthing parent-child pair, adjusted to 2021 US dollars. Investing in perinatal mental health prevention and treatment could improve health outcomes and reduce economic burden of PMADs on individuals, families, employers, and the state.

Systematic review and meta-analysis of postpartum depression and its associated factors among women before and after the COVID-19 pandemic in Uganda

OBJECTIVE

This meta-analysis aimed to estimate the national prevalence of postpartum depression (PPD) in Uganda and identify predictors in both pre-COVID-19 and post-COVID-19 eras.

DESIGN

Used a systematic review and meta-analysis methodology.

DATA SOURCES

Reviewed papers were sourced from Medline/PubMed, PsycINFO, CINAHL/EBSCOhost, Google Scholar, ScienceDirect and African Journals Online.

ELIGIBILITY CRITERIA FOR SELECTED STUDIES

The review encompassed observational studies published on PPD in Uganda from 1 January 2000 to 30 November 2023.

RESULTS

11 studies (involving 7564 participants) published from 1 January 2000 to 30 November 2023 were reviewed. The pooled prevalence of PPD in Uganda was 29% (95% CI 21% to 37%, I2=98.32%). Subgroup analysis indicated a similar prevalence before (29%, 95% CI 20% to 39%) and during (28%, 95% CI 22% to 32%) the COVID-19 period. Special groups exhibited a higher prevalence (32%, 95% CI 16% to 47%) than general postpartum women (28%, 95% CI 19% to 37%). Factors associated with PPD included poor social support (OR 1.19, 95% CI 1.17 to 1.22, I2=96.8%), maternal illness (OR 1.22, 95% CI 1.19 to 1.26, I2=96.9%), poor socioeconomic status (OR 1.43, 95% CI 1.40 to 1.46, I2=99.5%) and undergoing caesarean section (OR 1.15, 95% CI 1.12 to 1.17, I2=80.6%). Surprisingly, there was a marginal decrease in PPD during the COVID-19 period. Subgroup analysis highlighted a higher prevalence among mothers with HIV.

CONCLUSION

This study underscores the significant prevalence of PPD in Uganda, with sociodemographic factors increasing risk. Despite a slight decrease during the COVID-19 period, the importance of prioritising maternal mental health is emphasised, considering sociodemographic factors and pandemic challenges, to improve maternal and child health outcomes and overall well-being.

The impact of the Covid-19 pandemic on postnatal anxiety and posttraumatic stress: Analysis of two population-based national maternity surveys in England

BACKGROUND

Few studies have evaluated postnatal anxiety and posttraumatic stress (PTS) before and during the Covid-19 pandemic using comparable data across time. We used data from two national maternity surveys in England to explore the impact of the pandemic on prevalence and risk factors for postnatal anxiety and PTS.

METHODS

Analysis was conducted using population-based surveys carried out in 2018 (n = 4509) and 2020 (n = 4611). Weighted prevalence estimates for postnatal anxiety and PTS were compared across surveys. Adjusted risk ratios (aRR) were estimated for the association between risk factors and postnatal anxiety and PTS.

FINDINGS

Prevalence of postnatal anxiety increased from 13.7 % in 2018 to 15.1 % in 2020 (+1.4 %(95%CI:-0.4-3.1)). Prevalence of postnatal PTS increased from 9.7 % in 2018 to 11.5 % in 2020 (+1.8 %(95%CI:0.3-3.4)), due to an increase in PTS related to birth trauma from 2.5 % to 4.3 % (+1.8 %(95%CI:0.9-2.6); there was no increase in PTS related to non-birth trauma. Younger age (aRR = 1.31-1.51), being born in the UK (aRR = 1.29-1.59), long-term physical or mental health problem(s) (aRR = 1.27-1.94), and antenatal anxiety (aRR = 1.97-2.22) were associated with increased risk of postnatal anxiety and PTS before and during the pandemic, whereas higher satisfaction with birth (aRR = 0.92-0.94) and social support (aRR = 0.81-0.82) were associated with decreased risk.

INTERPRETATION

Prevalence of postnatal PTS was significantly higher during the pandemic, compared to before the pandemic, due to an increase in PTS related to birth trauma. Prevalence of postnatal anxiety was not significantly higher during the pandemic. Risk factors for postnatal anxiety and PTS were similar before and during the pandemic.

Disparities in Utilization and Delivery Outcomes for Women with Perinatal Mood and Anxiety Disorders

Perinatal mood and anxiety disorders (PMAD), which include depression and/or anxiety in the year before and/or after delivery, are common complications of pregnancy, affecting up to one in four perinatal individuals, with costs of over $15 billion per year in the US. In this paper, we provide an overview of the disparities in utilization and delivery outcomes for individuals with perinatal mood and anxiety disorders in the US. In addition, we discuss the current US screening and treatment guidelines as well as the high societal costs of illness of PMAD for both perinatal individuals and children. Finally, we outline opportunities for quality improvement of PMAD care in the US, including leveraging increased engagement with healthcare system during prenatal care, working toward a more cohesive national strategy to address PMAD, leaning into evidence-based policymaking through collaboration with a panel of experts, and generating state-level profiles focused on PMAD.

"A Judgment-Free Zone": Adaptation and Pilot Study of a Virtual Wellness Group for African American Mothers with Young Children

The COVID-19 pandemic has been particularly challenging for the mental health of African American (AA) birthing people. The pandemic necessitated shifting mental health care to online interventions. The goals of this study were to (1) describe an adapted evidence-based group preventive intervention for AA mothers with young children within a pediatric setting and (2) evaluate the feasibility, acceptability, and preliminary effectiveness of this virtual intervention. Phase 1 describes the adaptation of the HealthySteps Mom's Virtual Wellness Group, including eight weekly sessions based on the Mothers and Babies Course. Phase 2 was a mixed-methods, pre-post intervention design. Six AA mothers with young children completed questionnaires related to depression, anxiety, and parenting competence at three time points: pre-intervention (T1), post-intervention (T2), and 3 months post-intervention (T3). The participants also completed a focus group post-T2 to gather qualitative feedback regarding the intervention. The median scores for depression were lower at T2 and increased at T3, and for anxiety, they increased at T2 and decreased at T3. The median scores for parenting competence increased across the three time points. The participants attended a mean of 7.2 sessions (SD = 0.74). The qualitative results indicate that the participants gained a sense of empowerment, enjoyed connecting with other mothers, and acquired information. This pilot study suggests that a virtual intervention is feasible, acceptable, and can increase parenting competence and support among AA mothers with young children.

Prevalence and associated factors of probable depression amongst pregnant and parenting young females: a comparison of adolescents and young adults in rural South Africa

Background

Pregnant teenagers have been reported to have an increased likelihood of experiencing depression than their non-pregnant peers. There is little research on the risk factors for depression in rural Black adolescents and young adults, especially after the Covid-19 pandemic. Therefore, the current study aimed to identify the prevalence of probable depression and associated factors amongst pregnant and parenting young females.

Method

The study was a cross-sectional design, consisting of 362 pregnant and parenting adolescents and young adults aged 14-22. The study used the Edinburgh Postnatal Depression Scale (EPDS) to measure probable depression. Data were analyzed using Statistical Package for Social Sciences SPSS, version 27.0.

Results

The study found that the overall prevalence of probable depression was 42.8%. The study also found a relationship between alcohol consumption, lack of financial support, unplanned pregnancy, and probable depression in pregnant and parenting adolescents. The prevalence of unplanned pregnancy in the present study was 81.8%.

Conclusion

Furthermore, the present study indicated that participants from low socio-economic status families and those who were HIV positive were at a greater risk of depression in both groups. Therefore, we recommend that measures be put in place for early detection and treatment of depression and that social support be given to adolescent mothers.

The impact of prepartum pandemic-related perceived stress on anxiety symptoms in the postpartum: The role of perceived childbirth experiences

Postpartum anxiety is a significant component of postpartum maternal distress and is related to adverse outcomes for both the mother and the child. Although previous research reported higher anxiety symptoms in pregnant women during the Covid-19 pandemic, no studies evaluated the negative impact of pandemic-related perceived stress on postpartum anxiety symptomatology over time. This study aimed to examine the impact of prepartum pandemic-related stress on postpartum anxiety and to evaluate the role of subjective labor and delivery experiences on this relationship. A sample of 172 pregnant women completed an online questionnaire evaluating pandemic-related perceived stress and anxiety symptoms in the second or third trimester of pregnancy. In the postpartum, they completed a second questionnaire retrospectively evaluating their childbirth experience and assessing anxiety symptoms in the last two weeks. A mediation analysis was conducted. Prepartum pandemic-related perceived stress was significantly associated with postpartum anxiety symptoms. Moreover, childbirth experiences significantly and partially mediated this relationship. Findings highlighted the importance of evaluating perceived stress levels during pregnancy to prevent negative consequences on postpartum mental health. Clinicians need to foster better management of factors included in the childbirth experience that may potentially trigger or counteract anxiety risk.

Assessing the Risk of Depression Tendency in Pregnancy and Puerperium during COVID-19 Pandemic in Poland

The aim of the study was to assess the risk and severity of depression tendency in pregnant and postpartum women and to determine the relative risk for selected psychosocial and obstetric variables. The study included 317 women in the perinatal period. The severity of depressive disorders was assessed using standard self-report scales: EPDS (Edinburgh Postnatal Depression Scale), BDI-II (Depression Inventory-Second Edition), and HADS (Hospital Anxiety and Depression Scale). High rates of depression tendency in women in the third trimester of pregnancy were reported in 48.05% of pregnant women (≥10 EPDS scores), 49.36% (≥12 BDI II scores), and 41.55% (≥8 HADS-D scores). In contrast, in women in the first week after delivery, respectively: 33.74%; 28.83%; 22.08%. In the EPDS assessment, 11.69% of pregnant women and 17.79% of postpartum women confirmed the presence of self-injurious thoughts. A woman's diagnosis of depressive disorder before pregnancy increases the risk of postpartum depression tendency 3.35 times according to the EPDS, 3.51 times according to the BDI-II, and 4.89 times according to the HADS-D. Depressive disorders were significantly more common in pregnant women compared to women in the first week of postpartum. Systematic screening can identify risk factors for prenatal and postpartum depression.

Impact of a postpartum care rehabilitation program to prevent postpartum depression at a secondary municipal hospital in Qingdao China: a cross-sectional study

BACKGROUND

The emerging postpartum rehabilitation (PPR) program in Chinese hospitals characterized by applying ongoing medical care through traditional cultural practices shows a protective effect in early puerperium in China. This study explores the benefit of PPR program practices to postpartum depression (PPD) and the influencing factors for PPD among Chinese women during the first postnatal six weeks.

METHODS

The cross-sectional study included 403 participants and was conducted in a Secondary Municipal Hospital in Qingdao, China, from 01 to 2018 to 31 December 2021. Information on this PPR program was collected during the six-weeks postpartum consultation, including the Edinburgh postnatal depression scale (EPDS) scores, the measurement results for diastasis recti abdominis, and the international physical activity questionnaire (long form) (IPAQ-L) scores. Logistic regression models were used to examine the effect of the PPR program on PPD among the local population. The secondary aim of this study was to investigate possible influencing factors for PPD, such as coronavirus disease 2019 (COVID-19), physical exercises, etc. RESULTS: PPR program has shown a positive effect in preventing PPD (p < 0.001) and diastasis recti prevalence (p < 0.001) during the six-weeks postnatal control in Qingdao, China. Better post-pregnancy weight reduction (p = 0.04) and higher metabolic equivalent of task (MET) value (p < 0.001) were noticed in the non-PPR group. Furthermore, lower PPD risk was associated with factors such as longer relationship duration years (2-5 years) (p = 0.04) and exercising one to three times a week (p = 0.01). A higher PPD risk was related to factors such as urinary incontinence during the postpartum period (p = 0.04) and subjective insomnia (p < 0.001). No significant effect was shown between COVID-19 and the EPDS score in this study (p = 0.50).

CONCLUSION

Our results suggested that the PPR program provided protection against PPD and diastasis recti during the first six weeks after delivery. Urinary incontinence and subjective insomnia were the main risk factors for PPD, while longer relationship duration years and exercising one to three times a week gave protective effects to PPD. This study emphasized that a comprehensive ongoing medical care program, such as the PPR program, effectively improves women's mental and physical health in the early postpartum in China.

Postpartum experiences among individuals with suspected and confirmed prenatal generalized anxiety disorder during the COVID-19 pandemic: Implications for help-seeking

Prenatal generalized anxiety disorder (GAD) is a common and underdiagnosed condition with negative health consequences to both the pregnant individual and child. Here we studied the relationship between diagnosis and treatment status of GAD during pregnancy (no GAD diagnosis, suspected but not diagnosed, diagnosed but not treated, diagnosed and treated) during the COVID-19 pandemic and postpartum mental health outcomes, while considering the potential influence of individual psychological factors such as distress tolerance and resilience and the role of COVID-19-related health worries. In this sample of predominantly highly educated and white birthing individuals, one in five respondents experienced GAD during pregnancy and another one in six suspected GAD but was not diagnosed. Amongst those with a GAD diagnosis, 30% did not receive treatment. We found that those with a GAD diagnosis during pregnancy who did not receive treatment showed the highest levels of postpartum anxiety and depressive symptoms in the postpartum, even after controlling for covariates, and experienced the most COVID-19-related health worries. In comparison, individuals with a GAD diagnosis during pregnancy who received treatment experienced significantly lower anxiety symptom burden and depressive symptom burden, with a symptom burden similar to those without a confirmed or suspected diagnosis after controlling for individual psychological factors. We conclude that clinicians should strongly consider screening for and treating prenatal anxiety to prevent suboptimal postpartum mental health outcomes.

Perinatal mood and anxiety disorders: biomarker discovery using plasma proteomics

BACKGROUND

Perinatal mood and anxiety disorders encompass a range of mental health disorders that occur during pregnancy and up to 1 year postpartum, affecting approximately 20% of women. Traditional risk factors, such as a history of depression and pregnancy complications including preeclampsia, are known. Their predictive utility, however, is not specific or sensitive enough to inform clinical decision-making or prevention strategies for perinatal mood and anxiety disorders. Better diagnostic and prognostic models are needed for early identification and referral to treatment.

OBJECTIVE

This study aimed to determine if a panel of novel third-trimester plasma protein biomarkers in pregnant women can be used to identify those who have a high predisposed risk for perinatal mood and anxiety disorders within 3 months postpartum.

STUDY DESIGN

We studied 52 women (n=34 with a risk for perinatal mood and anxiety disorders and n=18 controls) among whom mental health screening was conducted at 2 time points, namely in the third trimester and again at 3 months postdelivery. An elevated perinatal mood and anxiety disorder risk was identified by screening individuals with above-validated cutoffs for depression (Edinburgh Postnatal Depression Scale ≥12), anxiety (Overall Anxiety Severity and Impairment Scale ≥7), and/or posttraumatic stress disorder (Impact of Events Scale >26) at both time points. Plasma samples collected in the third trimester were screened using the aptamer-based SomaLogic SomaScan proteomic assay technology to evaluate perinatal mood and anxiety disorder-associated changes in the expression of 1305 protein analytes. Ingenuity Pathway Analysis was conducted to highlight pathophysiological relationships between perinatal mood and anxiety disorder-specific proteins found to be significantly up- or down-regulated in all subjects with perinatal mood and anxiety disorder and in those with perinatal mood and anxiety disorders and no preeclampsia.

RESULTS

From a panel of 53 significant perinatal mood and anxiety disorder-associated proteins, a unique 20-protein signature differentiated perinatal mood and anxiety disorder cases from controls in a principal component analysis (P<.05). This protein signature included NCAM1, NRCAM, and NTRK3 that converge around neuronal signaling pathways regulating axonal guidance, astrocyte differentiation, and maintenance of GABAergic neurons. Interestingly, when we restricted the analysis to subjects without preeclampsia, a 30-protein signature differentiated perinatal mood and anxiety disorder cases from all controls without overlap on the principal component analysis (P<.001). In the nonpreeclamptic perinatal mood and anxiety disorder group, we observed increased expression of proteins, such as CXCL11, CXCL6, MIC-B, and B2MG, which regulate leucocyte migration, inflammation, and immune function.

CONCLUSION

Participants with perinatal mood and anxiety disorders had a unique and distinct plasma protein signature that regulated a variety of neuronal signaling and proinflammatory pathways. Additional validation studies with larger sample sizes are needed to determine whether some of these molecules can be used in conjunction with traditional risk factors for the early detection of perinatal mood and anxiety disorders.

Study characteristical and regional influences on postpartum depression before vs. during the COVID-19 pandemic: A systematic review and meta-analysis

Background

While the public is under serious pressure from the coronavirus disease 2019 (COVID-19), the final impact and possible contributing factors to postpartum depression symptoms (PPDS) remain unknown. Therefore, a meta-analysis to investigate the association between PPDS and the COVID-19 pandemic was carried out by comparing the data between pre-pandemic and post-pandemic timeframes and exploring the influencing factors.

Methods

This systematic review was prospectively registered and recorded in a study protocol (Prospero CRD42022336820, http://www.crd.york.ac.uk/PROSPERO). A comprehensive search of PubMed, Embase, Web of Science, CINALH, Cochrane and Scopus was cmpleted on June 6, 2022. Studies that compared the prevalence of PPD before and during the COVID-19 pandemic period were included.

Results

Of 1766 citations identified, 22 studies were included with 15,098 participates before the COVID-19 pandemic and 11,836 participants during the COVID-19 pandemic. Overall, the analysis showed that the epidemic crisis was associated with an increased prevalence of PPDS (OR: 0.81 [0.68, 0.95], P = 0.009, I ² = 59%). Subgroup analysis was conducted according to the study characteristics and regions. Within the study characteristics classification, results showed an obvious increase in the prevalence of PPDS during the COVID-19 pandemic if PPDS cutoff was defined as Edinburgh postpartum depression score (EPDS) ≥13 points (OR: 0.72 [0.52, 0.98], P = 0.03, I ² = 67%) and an increased prevalence in follow-ups that happened after 2 weeks (≥ 2 weeks postpartum) (OR: 0.81 [0.68, 0.97], P = 0.02, I ² = 43%). Selected studies that were high-quality (OR: 0.79 [0.64, 0.97], P = 0.02, I ² = 56%) demonstrated an increased prevalence of PPDS during the COVID-19 pandemic period. Sorting by regional factors, studies conducted in Asia (OR: 0.81 [0.70, 0.93], P = 0.003, I ² = 0%) showed an increase of PPDS prevalence rates during the COVID-19 period, while studies conducted in Europe (OR: 0.82 [0.59, 1.13], P = 0.23, I ² = 71%) and North America (OR: 0.66 [0.42, 1.02], P = 0.06, I ² = 65%) showed no significant difference. All studies conducted in the developed (OR: 0.79 [0.64, 0.98], P = 0.03, I ² = 65%) and developing countries (OR: 0.81 [0.69, 0.94], P = 0.007, I ² = 0%) showed an increase of PPDS during the COVID-19 period.

Conclusions

The COVID-19 pandemic is associated with an increased prevalence of PPDS, especially after long-term follow-up and among the group with a high possibility of depression. The negative influence from the pandemic, causing more PPDS was significant in studies from Asia.

The longitudinal effects of stress and fear on psychiatric symptoms in mothers during the COVID-19 pandemic

The COVID-19 pandemic has been particularly difficult for mothers. Women with a history of peripartum depression (PPD) may be vulnerable to relapse. We sought to understand changes in depressive and anxious symptoms throughout the pandemic and which stressors increased symptoms in women with a history of PPD. In June 2020, all US participants with a history of PPD (n = 12,007) in the global MomGenes Fight PPD study were invited to the COVID-19 follow-up study. Respondents (n = 2163, 18%) were sent biweekly and then monthly surveys until January 31, 2022. We employed time-varying effects models to evaluate trajectories of depressive (patient health questionnaire, PHQ-9) and anxious (generalized anxiety disorder, GAD-7) symptoms and to estimate longitudinal associations between perceived stress, fears, COVID-19 case rates, and symptoms. Peaks of PHQ-9, GAD-7, PSS, and perceived COVID-19 risk scores corresponded with timing of national COVID-19 case surges. High perceived stress was the strongest predictor of PHQ-9 (beta = 7.27; P = 1.48e - 38) and GAD-7 (beta = 7.73; P = 6.19e - 70). Feeling lack of control and unlikely to survive increased PHQ-9 and GAD-7 scores by 2 points. COVID-19 case rates, pandemic restrictions, and region were not independently associated with symptoms. This study suggests that the collective trauma of the pandemic has significantly affected mothers with a history of PPD, exemplified by high levels of perceived stress and the strong association with depressive and anxious symptoms. The next pandemic phase is uncertain, but will continue to influence mental health collectively and dynamically. Interventions must be flexible and responsive and should address fear, trauma, and feelings of control, particularly for mothers with a history of PPD.

Does the COVID-19 Pandemic Affect Labor-Related Anxiety and Prevalence of Depressive Symptoms in Pregnant Women?

The COVID-19 pandemic undoubtedly had significant effects on women’s health and the course of pregnancy. The aim of this single-center study was to explore the impact of the COVID-19 pandemic on adult pregnant and postpartum women’s mental health, as well as to identify factors associated with depressive symptoms, anxiety and fear of delivery. The 465 women included in this questionnaire-based cohort study were divided into two groups: one (controls) of women who gave birth before (n = 190), and the second who were pregnant and delivered during the pandemic (n = 275). The COVID-19 pandemic affected the severity of self-reported anxiety regarding childbirth (mean scores 2.7 vs. 2.36, p = 0.01). The depression (19.84 ± 13.23) and anxiety (16.71 ± 12.53) scores were higher in pregnant women during the COVID 19 pandemic, compared to women who gave birth before the pandemic (8.21 ± 7.38 and 11.67 ± 9.23, respectively). These findings demonstrate the magnitude of the pandemic’s impact on women’s mental health, and actions to improve the mental health of pregnant women in Poland may be crucial for maternal and fetal well-being.

The Influence of Maternal Psychological Manifestations on the Mother-Child Couple during the Early COVID-19 Pandemic in Two Hospitals in Timisoara, Romania

Background and objectives: The postpartum maternal physical and psychological state played a fundamental role in the mother−child relationship at the beginning of the COVID-19 pandemic. The aim of the study is to analyze the influence of maternal psychological manifestations on the mother−child couple through three objectives (briefly expressed): (I) Determination of the main acute and chronic conditions of newborns/infants. (II) Verification of the hypothesis of the existence of a link between the following neonatal variables: gestational age, birth weight, number of days of hospitalization, and specific neonatal therapies (oxygen, surfactant, and blood products’ transfusion). (III) Verification of the influence of postpartum maternal psychological status on the mother−child couple through three hypotheses. Materials and methods: This cross-sectional study was conducted in two hospitals in Timișoara, Romania, between 1 March and 1 September 2020, and included 165 mothers and their 175 newborns. Mothers answered the Edinburgh Postnatal Depression Scale, Spielberger’s Inventory of State-Trait Anxiety, and the Collins and Read Revised Adult Attachment Scale. Results: (I) The acute and chronic pathology of the infants in the study group was polymorphic. (II) Large correlations were identified between the following infant variables: gestational age with birth weight, and number of hospitalization days with birth weight, gestational age, and use of blood product transfusion (all p < 0.001). (III) (1) State anxiety was the only significant predictor of number of hospitalization days (p = 0.037), number of acute disorders (p = 0.028), and number of infant chronic diseases (p = 0.037). (2) Maternal depressive symptoms were the only predictor of postpartum maternal attachment (p = 0.018). (3) Depressive symptoms, state, and trait anxiety were non-significant in all models studied (all p > 0.05). Conclusions: Postpartum maternal physical and psychological state plays a fundamental role on the mother−child relationship in the new social and complex family conditions.

The Impact of COVID-19 on Maternal Mental Health during Pregnancy: A Comparison between Canada and China within the CONCEPTION Cohort

The effect of the COVID-19 pandemic on maternal mental health has been described in Canada and China but no study has compared the two countries using the same standardized and validated instruments. In this study, we aimed to evaluate and compare the impact of COVID-19 public health policies on maternal mental health between Canada and China, as we hypothesize that geographical factors and different COVID-19 policies are likely to influence maternal mental health. Pregnant persons >18 years old were recruited in Canada and China using a web-based strategy. All participants recruited between 26 June 2020 and 16 February 2021 were analyzed. Self-reported data included sociodemographic variables, COVID-19 experience and maternal mental health assessments (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7) scale, stress and satisfaction with life). Analyses were stratified by recruitment cohort, namely: Canada 1 (26 June 2020-10 October 2020), Canada 2 and China (11 October 2020-16 February 2021). Overall, 2423 participants were recruited, with 1804 participants within Canada 1, 135 within Canada 2 and 484 in China. The mean EDPS scores were 8.1 (SD, 5.1) in Canada 1, 8.1 (SD, 5.2) in Canada 2 and 7.7 (SD, 4.9) in China (p-value Canada 2/China: p = 0.005). The mean GAD-7 scores were 2.6 (SD, 2.9) in China, 4.3 (SD, 3.8) in Canada 1 (p < 0.001) and 5.8 (SD, 5.2) in Canada 2 (p < 0.001). When adjusting for stress and anxiety, being part of the Chinese cohort significantly increased the chances of having maternal depression by over threefold (adjusted OR 3.20, 95%CI 1.77-5.78). Canadian and Chinese participants reported depressive scores nearly double those of other crises and non-pandemic periods. Lockdowns and reopening periods have an important impact on levels of depression and anxiety among pregnant persons.

Adverse Mental Health Sequelae of COVID-19 Pandemic in the Pregnant Population and Useful Implications for Clinical Practice

The COVID-19 pandemic has increased risk of disturbances in the functioning of everyday life, directly or indirectly has influenced the risk of mental disorders in the most vulnerable populations, including pregnant women. The aim of this study was to analyze adverse mental health effects in the pregnant population during the COVID-19 pandemic, investigate risk factors for adverse mental health outcomes, identify protective factors, and create practical implications for clinical practice, bearing in mind the need to improve perinatal mental healthcare during such pandemics. Qualitative research was conducted in the electronic databases PubMed and Web of Sciences for the keywords COVID-19, pregnancy, depression, anxiety, and telemedicine for relevant critical articles (n = 3280) published from 2020 until October 2021, outlining the outcomes of control studies, meta-analysis, cross-sectional studies, face-to-face evaluation survey studies, remotely administered survey studies, and observational studies regarding the main topic; all were evaluated. Mental health problems among pregnant women linked to the COVID-19 pandemic, in most cases, show symptoms of depression, anxiety, insomnia, and PTSD and may cause adverse outcomes in pregnancy and fetus and newborn development, even at later stages of life. Therefore, useful implications for clinical practice for improving the adverse mental health outcomes of pregnant women associated with the COVID-19 pandemic are highly desirable. Our research findings support and advocate the need to modify the scope of healthcare provider practice in the event of a disaster, including the COVID-19 pandemic, and may be implemented and adopted by healthcare providers as useful implications for clinical practice.

Risk for postpartum depressive symptoms among pregnant women in a tertiary care setting with and without a positive COVID-19 test

OBJECTIVE

This study systematically examines risk for postpartum depressive symptoms based on COVID-19 positivity status during pregnancy.

METHODS

This is a retrospective matched cohort study of pregnant patients admitted to labor and delivery units from March through December 2020. Patients were administered three depression screening questions followed by the Edinburgh Postnatal Depression Scale (EPDS).

RESULTS

129 patients with positive COVID-19 tests (most with mild symptoms) were matched with 516 COVID-19 negative controls. We found no significant differences in rates of positive responses to screening questions (14/129, 10.9% vs. 72/516, 14.0%; p = .35) or EPDS scores >9 (6/97, 6.2% vs. 42/410, 10.2%; p = .22). Prior history of psychiatric illness was the only significant predictor of an EPDS score > 9 (adjOR 2.57, p = .002) or a positive brief screen for postpartum depressive symptoms (adjOR 2.93, p < .001).

CONCLUSIONS

No significant differences in the rates for postpartum depressive symptoms were observed among pregnant women with and without a positive COVID-19 test during pregnancy, suggesting that testing positive for COVID-19 during pregnancy was not associated with an increased risk for the development of depressive symptoms during the acute postpartum period. Overall rates of postpartum depression symptoms were low, perhaps owing to the higher socioeconomic status of the sample.