The COVID-ASSESS dataset - COVID19 related anxiety and stress in prEgnancy, poSt-partum and breaStfeeding during lockdown in Italy

The Emotional Landscape of Pregnancy and Postpartum during the COVID-19 Pandemic in Italy: A Mixed-Method Analysis Using Artificial Intelligence

The COVID-19 pandemic affected the perinatal emotional landscape in Italy, a country that had high mortality and implemented a strict lockdown during the pandemic. This study explores the emotions and challenges of pregnant and postpartum women during the pandemic, using AI-based mixed methods. The study analyzed 1774 women from the national survey COVID-ASSESS: 1136 pregnant and 638 postpartum women. The survey had qualitative questions on emotions and feelings related to birth, communication with healthcare professionals, media, and peers and family. We used natural language processing and machine learning to classify emotions, identify themes, and extract citations from the data. Fear and anxiety replaced joy as dominant emotions during the pandemic: trust and joy decreased by 49.3% and 36.4%, respectively, while sadness and fear increased by 52.3% and 49.3%, respectively. The pandemic also induced loneliness, isolation, frustration, and anger. Women faced challenges related to birth, communication with HCPs, media, and peers and family. They also used coping strategies such as self-care, news limitation, and trying to cultivate gratitude and hope. This study provides a comprehensive exploration of the perinatal emotional landscape of Italian women during the pandemic. The findings underscore the significant psychological impact of the pandemic and also highlight women's resilience and coping strategies.

The prevalence of mental ill-health in women during pregnancy and after childbirth during the Covid-19 pandemic: a systematic review and Meta-analysis

BACKGROUND

This systematic review aims to explore the prevalence of the impact of the COVID-19, MERS, and SARS pandemics on the mental health of pregnant women.

METHODS

All COVID-19, SARS and MERS studies that evaluated the mental health of pregnant women with/without gynaecological conditions that were reported in English between December 2000 - July 2021 were included. The search criteria were developed based upon the research question using PubMed, Science Direct, Ovid PsycINFO and EMBASE databases. A wide search criterion was used to ensure the inclusion of all pregnant women with existing gynaecological conditions. The Newcastle-Ottawa-Scale was used to assess the risk of bias for all included studies. Random effects model with restricted maximum-likelihood estimation method was applied for the meta-analysis and I-square statistic was used to evaluate heterogeneity across studies. The pooled prevalence rates of symptoms of anxiety, depression, PTSD, stress, and sleep disorders with 95% confidence interval (CI) were computed.

RESULTS

This systematic review identified 217 studies which included 638,889 pregnant women or women who had just given birth. There were no studies reporting the mental health impact due to MERS and SARS. Results showed that women who were pregnant or had just given birth displayed various symptoms of poor mental health including those relating to depression (24.9%), anxiety (32.8%), stress (29.44%), Post Traumatic Stress Disorder (PTSD) (27.93%), and sleep disorders (24.38%) during the COVID-19 pandemic.

DISCUSSION

It is important to note that studies included in this review used a range of outcome measures which does not allow for direct comparisons between findings. Most studies reported self-reported measure of symptoms without clinical diagnoses so conclusions can be made for symptom prevalence rather than of mental illness. The importance of managing mental health during pregnancy and after-delivery improves the quality of life and wellbeing of mothers hence developing an evidence-based approached as part of pandemic preparedness would improve mental health during challenging times.

OTHER

The work presented in this manuscript was not funded by any specific grants. A study protocol was developed and published in PROSPERO (CRD42021235356) to explore several key objectives.

Effects of the Covid-19 Pandemic on the Prevalence of Insomnia, Anxiety, and Depression During Pregnancy: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis study aims to determine the effects of the Covid-19 pandemic on the prevalence of insomnia, anxiety, and depression symptoms during pregnancy. Reviews were done through PubMed, EBSCO (Medline, CINAHL), Embase (OVID), Web of Science, PsycINFO, TR Index, Turkish Thesis Center databases using (pregnancy OR pregnant) and (sleep OR sleep disorders OR insomnia), and (anxiety OR depression) keywords between April and May 2021. The meta-analysis included 48 articles (sample: 77,299). It was found that the Covid-19 pandemic did not affect the prevalence of depression symptoms and anxiety during pregnancy, but it increased insomnia. While insomnia ratio was reported 39.6% (95% CI: 0.253-0.560) in the studies conducted before the pandemic, it was reported 88.8% (95% CI: 0.821-0.921) in the studies conducted during the pandemic. This study found that the Covid-19 pandemic did not have effects on depression symptoms and anxiety, but it increased insomnia complaints.

Exclusive breastfeeding and women's psychological well-being during the first wave of COVID-19 pandemic in Italy

Background

At the onset of the COVID-19 pandemic, support for breastfeeding was disrupted in many countries. Italy was severely impacted by the pandemic and is known to have the lowest exclusive breastfeeding rate of all European countries. Considering the inverse association between anxiety and breastfeeding, maternal concerns about the COVID-19 emergency could reduce breastfeeding rates. The aim of the study is to explore the association between infant feeding practices and maternal COVID-19 concerns.

Methods

This paper is a secondary analysis of the cross-sectional study COVID-ASSESS conducted in Italy in 2020. The original survey was administered in two phases: during the first lockdown and during the reopening. The survey included five sections: socio-demographic, medical history, concerns about the COVID-19 pandemic, infant feeding practices and psychometric evaluation. Participants were considered eligible for the post-hoc analyses if they were exclusively breastfeeding or they were feeding with infant formula (either alone or with breastfeeding) at the time of the interview.

Results

Between phase 1 and phase 2 there was a decrease in anxiety and concerns about the danger of COVID-19 to general health, except for concerns about their baby's health. Women using formula were more concerned about all the health topics investigated. Moreover, they showed higher levels of stress, state anxiety, somatization and PTSD symptoms.

Conclusion

Breastfeeding during the first pandemic lockdown in Italy seems to have been an independent factor associated with lower anxiety about COVID-19, fewer psychopathological symptoms, and a positive experience of infant feeding.

Stress Level to Dietary Habits among Adolescent in Indonesia during COVID 19 Outbreak: A Nationwide Survey

BACKGROUND: To suppress the COVID-19 transmissions, almost all activities related to physical and social activities between individuals are restricted. Activity restrictions such as lockdowns or physical-social distancing can trigger an elevation in stress. AIM: This study aimed to determine the correlation between stress levels and food habits among adolescents in Indonesia. METHODS: This cross-sectional study was conducted through an online questionnaire involving 5924 adolescents in all regions in Indonesia using the snowball sampling technique. RESULTS: The survey showed that most adolescents experienced high stress (55.6%). During the COVID-19 outbreak, they seemed rarely consumed or had an intake frequency of fewer than 3 times a day on carbohydrates (89.1%), animal protein (87.5%), vegetable protein (88.9%), vegetables (84.8%), fruit (90.6%), and snacks (86.3%). Statistically, their stress level did not significantly correlate to the consumption of those carbohydrates, animal protein, vegetable protein, vegetables, and fruit (p > 0.05), except for snacks (p < 0.002) at α = 0.05. Thus, the high-stress level was 1.267 times more at risk of snacking habit more often (more than 3 times a day) among adolescents in Indonesia during the COVID-19 outbreak. CONCLUSION: Stress level did not significantly correlate to the consumption of those carbohydrates, animal protein, vegetable protein, vegetables, and fruit. However, stress levels did not significantly correlate to snacks consumption.

Risk Factors for Postpartum Depression During COVID-19 Pandemic: A Systematic Literature Review

INTRODUCTION

The COVID-19 pandemic has had a devastating worldwide effect on mental health. Recent studies correlate the spreading of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with symptoms of depression, most prominent in postpartum women. Our systematic literature review scope is to identify the risk factors and predictors for postpartum depression (PPD) and describe the steps that should be taken to help postpartum women. This study will help clinicians, researchers, and policymakers to elucidate the predictors of PPD during this pandemic and prevent these adverse outcomes in future crises.

METHODS

We conducted a systematic search by employing databases PubMed, Google Scholar, Scopus, and Embase to identify articles published before March 2021. About 463 publications were generated during our search process and from those, 36 were reviewed, summarized, and synthesized. Studies qualified the criteria if they (1) utilized qualitative or quantitative design, (2) explored the risk factors for PPD, and (3) were written in English. Quality evaluation of each study was achieved by using criteria set by Lincoln and Guba.

RESULTS

Prevalence of depression symptoms ranged from 7% to 80.8% in postpartum women during the SARS-COV 2 pandemic. The risk factors for PPD were classified into 6 major categories: socio-demographic, psychological, pre-existing pathology, metabolic factors, previous events of miscarriage, and media misinformation.

CONCLUSION

It is extremely vital to care for women's mental health during pregnancy and after childbirth during these unprecedented times. This review urges the need to design adequate interventions for this vulnerable population to prevent negative consequences of PPD.

Narrative review: COVID-19 and pediatric anxiety

The coronavirus (COVID-19) pandemic has brought focus to the effects of anxiety on children. This study aimed to review the existing literature regarding the impact of the pandemic on pediatric anxiety. This review analyzed the existing literature between the open-sourced collection on PubMed inputting "anxiety disorder in children during pandemic" and "pediatric anxiety OR child anxiety AND COVID" and that of the Journal of the American Academy of Child & Adolescent Psychiatry using the keywords "social anxiety AND COVID." This yielded 149 + 312 (461) entries and 68 articles were selected. Anxiety was found to have a prevalence of 18.9-23.87% in children during the COVID-19 pandemic whereas adolescent populations demonstrated a prevalence of 15.4-39.9%. Female gender was the most studied risk factor and physical activity was the most documented preventative factor. This review supported the notion that the COVID-19 pandemic is a major contributor to anxiety in the pediatric population.

Does time change the anxiety and depression scores for pregnant women on Covid-19 pandemic?

Objective

Post‐traumatic stress disorder, the tip form of stress disorder, is considered as delayed onset if the symptoms occur at least 6 months after the main effect. The aim of our study was to evaluate the severity of anxiety and depression in pregnant women during the coronavirus disease (COVID‐19) pandemic, in addition to investigating the demographic and economic aspects affecting maternal anxiety and depression scores, 6 months after the onset of the COVID‐19 pandemic.

Methods

Our study was a cross‐sectional descriptive study. Pregnant women who had presented to the Akdeniz University, Gynecology and Obstetrics Department, Pregnancy Outpatient Clinic, and Kepez State Hospital, Pregnancy Outpatient Clinic between September 2020 and October 2020 were included in the study. The Spielberger State–Trait Anxiety Inventory (STAI) was used to evaluate the state of anxiety, and the Beck Depression Inventory‐II (BDI‐II) was used to assess the state of depression. Patients who had encountered any obstetric and/or fetal abnormality that could cause anxiety and depression during pregnancy follow‐up and pregnant women previously diagnosed with a psychiatric disease were not included in the study.

Results

A total of 322 pregnant women who agreed to participate in the study and fulfilled the study criteria within the afore‐mentioned timeframe were included in the study and the relevant forms were filled out. The mean age of the pregnant women was found to be 29 ± 5.64 years, the mean number of gravida was 1.84 ± 0.86, and the mean gestational age was 29.06 ± 9.80 weeks. The mean score of the state anxiety scale was 41.7 ± 5.56 and the mean trait anxiety score was 47.68 ± 5.85. The mean state–trait anxiety score was determined as 42.5 in primigravid women and as 41.1 in multigravid women. The State–trait anxiety score was statistically significantly higher in primigravid women compared to multigravid women (p = 0.027). The mean state–trait anxiety score did not demonstrate a significant difference according to the occupational status, having a chronic disease, educational level, and the income level. The mean trait anxiety score did not differ statistically and significantly according to the occupational status, having a chronic disease, being primigravid, educational status, and the income level. According to BDI‐II, 69.3% of pregnant women were evaluated to have minimal depression, 12.4% as mild depression, 12.4% as moderate depression, and 5.9% as severe depression.

Conclusion

Although more than 6 months have passed since the onset of the COVID‐19 pandemic, pregnant women still have increased anxiety and depression scores. In addition, it should be kept in mind that pregnant women are at risk in terms of post‐traumatic stress disorder during the antenatal and the postnatal periods, and it should be considered that psychological and social support should be provided.

One Year Into the Pandemic: A Systematic Review of Perinatal Mental Health Outcomes During COVID-19

Obstetric guidelines have rapidly evolved to incorporate new data and research on the novel coronavirus disease (COVID-19), with data on perinatal mental health building over the last year. Our aim in the present manuscript is to provide a systematic review of mental health outcomes in pregnant and postpartum women during the COVID-19 pandemic in the context of neonatal and obstetric guidelines addressing symptoms and complications of COVID-19 during pregnancy, mother-to-neonate transmission, Cesarean-section delivery, neonatal prematurity, maternal/neonate mortalities, maternal-neonatal separation, and breastfeeding. We summarize data from 81 mental health studies of pregnant and postpartum women and underscore protective and risk factors identified for perinatal mental health outcomes amidst the COVID-19 pandemic. Data reviewed here suggest increased psychological symptoms, especially depressive and anxiety symptoms, in pregnant and postpartum women during COVID-19. Our systematic review integrates the most current obstetric and neonate guidelines, along with perinatal mental health outcomes associated with COVID-19, highlighting the best available data for the care of women and their neonates amidst the current COVID-19 pandemic.

The COVID-ASSESS dataset - COVID19 related anxiety and stress in prEgnancy, poSt-partum and breaStfeeding during lockdown in Italy

The COVID-ASSESS questionnaire (COVID-19 related Anxiety and StreSs in prEgnancy, poSt-partum and breaStfeeding) was developed and distributed by CiaoLapo Foundation, an Italian charity for healthy pregnancy and perinatal loss support. Data were collected during phase 1 and phase 2 of COVID-19 lockdown in Italy (March, April and May 2020). The final dataset consists of 2448 women, of whom 1307 during pregnancy and 1141 women during post-partum or breastfeeding period. Variables collected for each subject are: sociodemographic and clinical information (previous losses, history of psychological disorders), birth expectations before and after COVID-19, concerns regarding pandemic consequences, perception of media and health professionals' information and communication on COVID-19, psychopathological assessment (anxiety, post-traumatic stress and general psychopathology).

Previous psychopathology predicted severe COVID-19 concern, anxiety, and PTSD symptoms in pregnant women during "lockdown" in Italy

Italy was the first COVID-19 pandemic epicenter among European countries and established a period of full "lockdown", consisting of travel bans, mandatory staying at home, and temporary closure of nonessential businesses. Similar measures are known risk factors for psychological disturbances in the general population; still, little is known about their impact on pregnant women's mental health during COVID-19 pandemic. The cross-sectional, web-based, national survey "COVID-19 related Anxiety and StreSs in prEgnancy, poSt-partum and breaStfeeding" (COVID-ASSESS) was conducted during the first month of full "lockdown" in Italy. Participants were recruited via social networks with a snowball technique. The questionnaire was specifically developed to examine COVID-19 concerns and included the psychometric tests National Stressful Events Survey (NSESSS) for posttraumatic stress disorder (PTSD) and State-Trait Anxiety Inventory. A multivariable logistic regression model was fitted to explore the association of the concern, anxiety and PTSD symptoms with age, gestational weeks, parity, days of "lockdown", assisted reproductive technology use, psychopathological history, and previous perinatal losses. Out of 1015 pregnant women reached, 737 (72.6%) fully answered the questionnaire; no woman reported a COVID-19 infection. Median age was 34.4 years [quartiles 31.7, 37.2], median days in "lockdown" were 13.1 [11.0, 17.0], median gestational weeks were 27.8 [19.8, 34.0]. Clinically significant PTSD symptoms were present in 75 women (10.2%, NSESSS cutoff 24) and clinically significant anxiety symptoms were present in 160 women (21.7%, STAI-Y1 cutoff 50). Women were particularly worried about the health of their baby and of their elderly relatives, as well as of the possible impact of pandemic in the future of society. Previous anxiety predicted higher concern and PTSD symptoms; previous depression and anxiety were independently associated with current PTSD symptoms.