Global prevalence of depression, anxiety, and stress symptoms in different trimesters of pregnancy: A meta-analysis and meta-regression

The global prevalence of psychological problems in different trimesters is unclear due to methodological constraints in previous reviews. A precise estimate would be a key first step in raising awareness and allocating resources. This review aims to (1) calculate the global prevalence of depression, anxiety, and stress symptoms during different trimesters and (2) determine the factors influencing their prevalence estimates. A comprehensive search across eight databases was conducted. The meta packages in R software were used to perform meta-analysis, subgroup analysis, and meta-regression analysis. The Newcastle Ottawa Scale was used to assess the study quality, while the Grading of Recommendations, Assessment, Development, and Evaluation method was utilized to assess the certainty of the evidence. A total of 88 studies with 61,719 participants across 48 countries were included. The prevalences of depression, anxiety, and stress symptoms during all trimesters were 27% (95% CI: 23-31), 37% (95% CI: 31-42), and 26% (95% CI: 9-49), respectively. The second trimester had the highest prevalence of depression (30%) and anxiety (28%) symptoms, whereas the third trimester had the highest prevalence of stress symptoms (52%). A series of subgroup and meta-regression analyses revealed that regions, economic levels of the country, setting, the COVID-19 pandemic, and quality of study were significant factors. Most studies were high quality, but the certainty of the evidence was very low. Findings can contribute as evidence to raising awareness about specific psychological problems during different trimesters. Implementing effective policies and launching targeted interventions can help minimize the prevalence.

The Impact of the COVID-19 Pandemic on Health Behaviours of Pregnant Women in Poland: A Cross-Sectional Study

Health behaviours of pregnant women should promote an optimal course of pregnancy and maternal health. The purpose of this study was to assess the impact of COVID-19 pandemic on pregnant women's health behaviours (proper eating habits with a particular focus on the type of food consumed; preventive behaviours in terms of compliance with health recommendations and obtaining information on health and disease; healthy practices-daily habits in terms of sleep, rest and physical activity; as well as positive mental attitudes-avoiding strong emotions, stress, and depressing situations, determined by the frequency of each behaviour reported by the respondents). The study included women at different stages of pregnancy and women who were pregnant during the COVID-19 pandemic. A total of 355 women participated in the study. The study used a proprietary questionnaire and the Health Behaviour Inventory (HBI). The overall health behaviour score during the pandemic was higher (85.87) than the pre-pandemic score (82.16). There was a statistically significant difference between the total pre-pandemic and during-pandemic HBI scores. Additionally, there was an increase in the total score in each of the health behaviour domains during the pandemic period compared to the pre-pandemic results. During the COVID-19 pandemic, pregnant women presented a statistically significantly higher rate of health behaviours, as measured with the HBI, indicating that respondents were more likely to engage in health-promoting behaviours. The study has shown a positive change in pregnant women's eating habits, which can potentially affect the health of the population in the future.

Positive and Negative Affect Schedule in early COVID-19 pandemic

The COVID-19 pandemic is the first pandemic in the Information Age. It started in Asia and spread rapidly around the world. As a consequence, millions of people were subject to lockdowns, and traditional media and social media reached more people. Our study, carried out during the lockdown, asked people about their feelings and emotions and included a Positive and Negative Affect Schedule (PANAS). Here, we present the data resulting from that study, which could potentially be reused by psychologists interested in learning about the emotional effects of the COVID-19 pandemic as well as to make comparisons before and after the lockdown period in 2020.

Vitamins and minerals, education, and self-care need during preconception to 1000 days of life in Southeast Asia: An expert panel opinion

Addressing maternal malnutrition and its drivers is paramount in Southeast Asia. This article summarizes the key clinical learnings and evidence-based opinions from the experts to understand the need for vitamins and minerals supplementation, education, and self-care from preconception to the first 1000 days of life, which warranted further attention since COVID-19 pandemic. Evidence describing the importance of vitamins and minerals during preconception, pregnancy, and lactation stages was identified using literature databases. A pre-meeting survey was conducted to determine the current practices and challenges in Southeast Asia. Based on the literature review and clinical experience, experts defined the topics, and an online meeting was held on 13th July 2021. During the meeting, nine experts from Southeast Asia provided evidence-based opinion on the vitamins and minerals supplementation, education, and self-care need during preconception, pregnancy, and lactation stages. The expert opinions underpin maternal malnutrition as a prevalent issue and discuss appropriate interventions and prevention strategies for women in Southeast Asia. The recent pandemic further impacted nutrition status, pregnancy, and neonatal health outcomes. The expert panel emphasized a need to improve existing inadequacies in education, self-care, and social support, and discussed the role of policymakers in addressing the barriers to dietary changes. As inadequacies in regular vitamins and minerals supplementation, education, and self-care for women of reproductive age implicate maternal and child health outcomes, there is an urgent need for addressing malnutrition concerns in this population. Thus, a strong partnership between policymakers, healthcare professionals, and other relevant sectors is required.

Maternal COVID-19 vaccine acceptance among Malaysian pregnant women: A multicenter cross-sectional study

Introduction

The coronavirus disease 2019 (COVID-19) caused a global pandemic that resulted in devastating health, economic and social disruption. Pregnant mothers are susceptible to COVID-19 complications due to physiological and immunity changes in pregnancy. We aimed to assess the maternal vaccine acceptance of the COVID-19 vaccine.

Methods

A multi-center study across four teaching hospitals in the Klang Valley, Malaysia was conducted between September 2021 and May 2022. A survey was conducted using a self-administered electronic questionnaire. The survey instruments included; (1) maternal perception and attitude toward COVID-19 vaccination, (2) COVID-19 pregnancy-related anxiety, and 3) generalized anxiety disorder.

Results

The response rate was 96.6%, with a final number for analysis of 1,272. The majority of our women were Malays (89.5%), with a mean age (standard deviation, SD) of 32.2 (4.6). The maternal vaccine acceptance in our study was 77.1%. Household income (p < 0.001), employment status (p = 0.011), and health sector worker (p = 0.001) were independent predictors of maternal willingness to be vaccinated. COVID-19 infection to self or among social contact and greater COVID-19 pregnancy-related anxiety were associated with increased odds of accepting the SARS-CoV-2 vaccine. Women who rely on the internet and social media as a source of vaccine information were more likely to be receptive to vaccination (adjusted odd ratio, AOR 1.63; 95% CI 1.14-2.33). Strong correlations were observed between maternal vaccine acceptance and the positive perception of (1) vaccine information (p < 0.001), (2) protective effects of vaccine (p < 0.001), and (3) getting vaccinated as a societal responsibility (p < 0.001).

Discussion

The high maternal vaccine acceptance rate among urban pregnant women in Malaysia is most likely related to their high socio-economic status. Responsible use of the internet and social media, alongside appropriate counseling by health professionals, is essential in reducing vaccine hesitancy among pregnant women.

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.

Knowledge and Expectations of Perinatal Care Among Pregnant Women During the COVID-19 Pandemic

Introduction

This study aimed to investigate the knowledge and expectations of pregnant women on perinatal care during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

A cross-sectional survey was conducted among pregnant women ≥21 years, without a history of confirmed COVID-19, attending antenatal clinics between August and September 2020 via a secure online platform. The survey consisted of 10 questions which evaluated the knowledge and expectations on perinatal and neonatal care during the current pandemic.

Results

A total of 313 pregnant women completed the survey. The mean age of the participants was 30 years (SD 4; range 22-43 years). The median gestational age was 25 weeks (range 4-40 weeks). The participants were predominantly multiparous (54%) and almost all (98%) had completed secondary level education. Majority of participants were aware of the spread of COVID-19 by respiratory secretions and contact (90%), and the importance of prevention strategies (94%). Up to 72% agreed or strongly agreed that in-utero transmission of SARS-CoV-2 was possible. Most were unsure of the optimal mode of delivery (77%) and only 22% believed that breastfeeding was safe in a pregnant woman with active COVID-19. Although 46% were concerned about increased transmission risk with antenatal clinic visits, only 37% were agreeable to teleconferencing of clinic appointments. Maternal age >35 years was significantly associated with agreement with separation of mother-infant after birth [AOR 1.89 (95% CI 1.05, 3.39)], restrictions of visitors during the postnatal period [1.92 (1.05, 3.49)] and having their confinement practices were affected [2.3 (1.26, 4.17)]. Pregnant women who were multiparous disagreed that breastfeeding was safe in women with active COVID-19 [0.42 (0.23, 0.75)].

Conclusions

There was significant uncertainty about the optimal delivery method and safety of breastfeeding with COVID-19 among expectant mothers, along with variable agreement with alterations to routine perinatal care.

Depression in pregnant and postpartum women during COVID-19 pandemic: systematic review and meta-analysis

Coronavirus disease 2019 (COVID-19) emerged as a global pandemic in March 2020 and caused a big crisis, especially the health crisis. Pregnant and postpartum women experienced significant physical, social, and mental changes that put them at higher risk for several conditions during the pandemic. This study aimed to report the prevalence of depression in pregnant and postpartum women during the COVID-19 pandemic. Eligible studies were identified using several databases. Prevalence analysis was conducted using MedCalc ver. 19.5.1. This systematic review and meta-analysis was registered in PROSPERO on July 12, 2021 with registration number CRD42021266976. We included 54 studies with 95.326 participants. The overall prevalence of depression was 32.60% among pregnant and postpartum women during the COVID-19 pandemic. The rate was higher among pregnant women (31.49%) compared to postpartum women (27.64%). The prevalence of depression among pregnant and postpartum women increased during the COVID-19 pandemic.

Internet-delivered psychological interventions for reducing depressive, anxiety symptoms and fear of childbirth in pregnant women: A meta-analysis and meta-regression

OBJECTIVE

The current review aims to (1) investigate the effectiveness of Internet-based psychological intervention in reducing depressive, anxiety, and stress symptoms and fear of childbirth among pregnant women at post-intervention and follow-up; (2) compare the effects of the intervention using different psychological principles; and (3) explore potential covariates on the intervention effect.

METHODS

A literature search of seven databases was carried out to identify published and unpublished randomized controlled trials (RCTs) in English without any time limitation up to February 2021. Meta-analysis and meta-regression were conducted using Comprehensive Meta-analysis software. This review protocol was registered on PROSPERO (CRD42021235565).

RESULTS

Sixteen RCTs involving 3894 pregnant women were included from more than 23 countries. Internet-delivered psychological interventions were found to significantly (p < 0.05) reduce depressive (g = -0.16 to -0.32) and anxiety (g = -0.22 to -0.33) symptoms with small effect sizes at post-intervention and follow-up during 6 to 8 weeks postpartum compared with those in the comparator group. However, there was insufficient evidence for fear of childbirth and stress symptoms. Our subgroup analyses found that psychological interventions adopting component of cognitive behavioral therapy (g = -0.29) or mindfulness therapy (g = -0.62) showed beneficial effects to improve depressive symptoms among pregnant women. Univariate random-effect regression analyses showed that the attrition rate was a significant covariate (Z = -2.33, p = 0.02) on depressive symptoms. The certainty of main outcomes was graded from low to very low in accordance with the GRADE criteria.

CONCLUSIONS

Our reviews suggested that Internet-delivered psychological intervention may complement usual antenatal care in the improvement of depressive and anxiety symptoms. Future trials involving a large-scale sample are needed to improve the methodological quality.

Emotional Experiences of Pregnant and Postpartum People with Confirmed or Suspected COVID-19 Infection During the Initial Surge of the Pandemic

Objectives:

The COVID-19 pandemic may have a unique emotional impact on pregnant people. This qualitative study aimed to characterize the emotional effects of the COVID-19 pandemic on pregnant and recently pregnant patients who had either suspected or confirmed COVID-19 infection during the initial 6 months of the pandemic.

Methods:

Pregnant and recently pregnant participants (n = 20) from Massachusetts General Hospital Obstetrics and Gynecology clinical sites with suspected or confirmed COVID-19 infection were interviewed about their experiences during the COVID-19 pandemic. Interviews were transcribed and coded using NVivo 12 software. Using data display matrices, thematic analysis was performed to identify emergent, crosscutting themes.

Results:

Twenty pregnant and postpartum patients participated of whom 12 had confirmed COVID-19 infection and 8 had suspected infection. The most frequently described emotions were anxiety (90%), uncertainty (80%), fear (70%), relief (65%), and sadness (60%). The following three crosscutting themes were identified: risk, protection, and change. The ways in which participants articulated their emotional reactions to the themes of risk, protection, and change were complex and varied.

Conclusions:

There was a broad range of negative and positive emotional experiences of pregnancy, birth, and the postpartum period during the first 4 months of the COVID-19 pandemic. A better understanding of pregnant people's emotional experiences may lead to changes in clinical practice and institutional policies that are more supportive of their needs and congruent with their values.

The COVID-19 Pandemic and Levels of Physical Activity in the Last Trimester, Life Satisfaction and Perceived Stress in Late Pregnancy and in the Early Puerperium

Background: The aim of this study was to determine the impact of the COVID-19 pandemic on the levels of physical activity during the third trimester of pregnancy, life satisfaction and stress in women in late pregnancy and early postpartum. Methods: The study was conducted among 740 patients of maternity wards in Cracow hospitals on days 1−8 postpartum. Patients who were surveyed before the pandemic (December 2019−March 2020) were included in the prepandemic group (PPan: n = 252). The second group of women (COVID 1 group, Cov1: n = 262) was examined in the early stages of the pandemic (May−September 2020). In turn, participants who were surveyed during the population vaccination campaign (June−September 2021) were qualified to the COVID 2 group (Cov2: n = 226). The research tools used were the original questionnaire in addition to standardized questionnaires assessing physical activity in the last trimester of pregnancy (the Pregnancy Physical Activity Questionnaire); previous life satisfaction (the Satisfaction with Life Scale); and stress levels during the last month (the Perceived Stress Scale). Results: During the pandemic, women reduced the level of energy spent on total physical activity; nevertheless, statistically significant differences were found only between the PPan and Cov2 groups (p = 0.001). At the early stages of the pandemic, patients significantly reduced mobility activities (Cov1 vs. PPan: p < 0.001; Cov1 vs. Cov2: p = 0.007), while late in the pandemic they spent less energy on household activities (Cov2 vs. PPan: p = 0.002, Cov2 vs. Cov1: p = 0.002). There were no differences in the levels of stress and life satisfaction. Conclusions: The COVID-19 pandemic impacted the level of physical activity; however, it did not change levels of perceived stress and life satisfaction in women in late-stage pregnancy and in the early puerperium.

Maternidade em tempos de pandemia de Covid-19: o que nos revelam as mães atendidas em um hospital de referência

A pandemia de Covid-19 afetou todas as esferas da nossa vida. Mulheres no período perinatal têm necessidades únicas, demandando diretrizes de saúde e segurança devido aos riscos do isolamento social. Objetivou-se conhecer a vivência de mulheres na gestação ou puerpério no contexto da pandemia durante atendimento em hospital de referência. Estudo qualitativo pautado em referenciais da integralidade do cuidado e cotidiano. Participaram 18 mulheres, gestantes e puérperas. Três temas emergiram: repercussões na gestação e puerpério; repercussões na vida prática; e estratégias de enfrentamento criadas pelas mulheres. Os relatos desvelam diferentes repercussões da pandemia na vida das mulheres e de suas famílias, bem como estratégias e cuidados usados para mitigar os efeitos adversos. Sugere-se o direcionamento de medidas preventivas e políticas públicas que priorizem mulheres grávidas e puérperas, reconhecendo e acolhendo questões subjetivas envolvidas nesse momento na vida da mulher.

The socioeconomic apprehensions of a pregnant woman around COVID-19 – Do we need to be worried?

Introduction:

Coronavirus 2019 (COVID-19) pandemic has become the most severe intercontinental health challenge and pregnant women are deemed to be a special population group. The COVID-19-related restrictions on visiting the hospital for antenatal check-up and procedures may be distressing for them. The present study aims at assessing the level of anxiety and risk perception of pregnant women during the pandemic.

Materials and Methods:

This cross-sectional observational study included all pregnant women who were above 18 years of age, irrespective of their gestational age. They were administered the pre-designed, pre-tested questionnaire via face-to-face interview. The effect of the COVID-19 pandemic and its influence on women’s experience including her worries were collected. Data analysis was done using SPSS software version 22.

Results:

A total of 130 pregnant women with a mean maternal age of 26.1 ± 6.5 years were enrolled in the study. The mean gestational age of the women was 19 ± 4.7 weeks and most of them were in the second trimester (48.5%). Most of the pregnant women encountered the adverse socioeconomic influence of COVID-19 on their daily life (55.6% somewhat, 9.1% moderately so, 1.1% very much). Majority of them reported that they had limited their social activities (78.5%) and amorous relationship with their partner (30.8%). Also, around 59.2% of antenatal women experienced a moderate level and 40.7% had a mild level of anxiety.

Conclusion:

It is essential for obstetric providers to do prompt identification of mental health concerns in perinatal women and to liaise with mental health professionals to provide relevant interference.

Psychological Impact of the COVID-19 Pandemic on Pregnant Women: A Scoping Review

During the gestation period, pregnant women experience physical and psychological changes, which represent vulnerability factors that can boost the development of mental health conditions. The COVID-19 pandemic is producing new changes in the routines of the whole society, especially on lifestyle habits. The psychological impact associated with the COVID-19 pandemic and pregnant women remains unclear. A scoping review regarding the psychological impact of the COVID-19 pandemic on pregnant women was conducted. Searchers were conducted using the PubMed, Web of Science and CINAHL databases. Articles in Spanish, English and French were included. The search was conducted between November 2020 and September 2021. We identified 31 studies that evaluated 30,049 expectant mothers during the COVID-19 pandemic. Pregnant women showed high levels of anxiety and depression symptomatology. Fear of contagion and concerns regarding the health of the fetus were identified as the main variables related to psychological distress. An increase of the levels of depression, anxiety and stress during the COVID-19 pandemic amongst pregnant women has been observed. Moreover, an increased vulnerability of the fetus due to placental metabolic alterations is discussed. This review suggests that the COVID-19 pandemic is associated with a negative psychological impact on pregnant women. Thus, high levels of anxiety and depression symptoms suggest the need for a systematic approach.

Self-Fetal Wellbeing Monitoring and Ante-Natal Care during the COVID-19 Pandemic: A Qualitative Descriptive Study among Pregnant Women in Indonesia

Pregnant women are expected to have a high level of awareness when it comes to checking their fetal health and ensuring their welfare. This study explored the experiences of pregnant women in Indonesia who were monitoring their fetal wellbeing during the COVID-19 pandemic. A qualitativedescriptive study design with a constructivist paradigm was used. Twenty-two pregnant women were recruited and participated in a semi-structured interview. Analysis of the transcribed interviews used a content, thematic and comparative process. Three themes emerged from the analysis: feelingsand responses, changes to the ante natal care service during the COVID-19 pandemic, and the fetal wellbeing monitoring, tools, and methods used. Advice on how pregnant women should conduct fetal wellbeing monitoring during COVID-19 is urgently needed. The results of this study indicate there is a need for interventions to help pregnant women carry out self-fetal wellbeing monitoring in times where they have fewer contacts with health professionals such as during the COVID-19 pandemic.

Maternal meal irregularities during pregnancy and lifestyle correlates

Meal regularity can influence metabolic health. However, habits of skipping and delaying meals are rarely studied among pregnant women. This study examined the incidence of maternal meal skipping and meal delaying, and their associated lifestyle patterns during pregnancy. Pregnant women in the second trimester (18-24 weeks' gestation; n = 90) were recruited from the antenatal clinics in KK Women's and Children's Hospital, Singapore, 2019-2020. Data on sociodemographic, lifestyle and dietary habits were collected. Firstly, principal component analysis was used to identify lifestyle patterns. Subsequently, multiple logistic regression model was used to examine the association of lifestyle patterns with meal skipping and delaying. In total, 32 (35.6%) women had irregular meals, in which 25 (27.8%) and 26 (28.9%) women reported meal skipping and meal delaying for at least 3 times a week, respectively. Women with 'poor sleep and emotion' pattern as characterized by higher scores for poor sleep, depression, anxiety, and stress symptoms were associated with higher odds of meal skipping (OR 1.99; 95% CI 1.13, 3.53) and meal delaying (2.50; 1.31, 4.79). 'Sedentary' pattern, as characterized by greater daily time spent on television and screen electronic devices, and 'weight and inactivity' pattern, as characterized by higher BMI and physical inactivity level, were not associated with meal regularity. In this study, almost one-third of women reporting meal irregularities during pregnancy. 'Poor sleep and emotion' pattern is associated with a higher incidence of meal skipping and delaying. These findings suggest the need to address sleep and emotional health in interventions promoting healthy nutrition specifically regular eating in pregnancy.

One Year on: An Overview of Singapore's Response to COVID-19-What We Did, How We Fared, How We Can Move Forward

Background-One year has passed since the first COVID-19 case in Singapore. This scoping review commemorates Singaporean researchers that have expanded the knowledge on this novel virus. We aim to provide an overview of healthcare-related articles published in peer-reviewed journals, authored by the Singapore research community about COVID-19 during the first year of the pandemic. Methods-This was reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) protocol. It included healthcare-related articles about COVID-19 published between 23 January 2020 and 22 January 2021 with a Singapore-affiliated author. MEDLINE, Embase, Scopus, Web of Science, CINAHL, PsycINFO, Google Scholar, and local journals were searched. The articles were screened independently by two reviewers. Results-The review included 504 articles. Most of the articles narrated the changes to hospital practice (210), while articles on COVID-19 pathology (94) formed most of the non-narrative papers. Publications on public health (61) and the indirect impacts to clinical outcomes (45) were other major themes explored by the research community. The remaining articles detailed the psychological impact of the pandemic (35), adaptations of medical education (30), and narratives of events (14). Conclusion-Amidst a resurgence of community cases involving variant COVID-19 strains, the resources from the research community will provide valuable guidance to navigate these uncertain times.

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 Psychological Impact of the COVID-19 Pandemic on Pregnant Women

BACKGROUND

The COVID-19 pandemic has meant significant precautions and changes in delivering healthcare services. The aim of the study was to explore the lifestyle changes of pregnant women during the COVID-19 pandemic in Romania, the changes in prenatal care and delivery during the pandemic and the psychological impact on women and to determine how healthcare providers can help them to overcome this period.

METHODS

A cross-sectional survey was conducted anonymously and distributed among pregnancy-related groups from Romania, recruiting 559 study participants, between May and October 2020. A total of 559 pregnant women completed an online 26-item questionnaire but we only validated 557 responses for study. The survey included basic demographic questions, pregnancy-related questions, questions regarding the pregnant women's lifestyle changes during the pandemic and their perception of the COVID-19 pandemic and questions which evaluated the impact of the pandemic on prenatal care and delivery in Romania.

RESULTS

The pandemic restrictions affected women's routine activities regarding professional, familial and social life. Therefore, for pregnant women who were emotionally vulnerable, these restrictions had a great impact on their mental health. The majority of the study participants (78.8%, N = 439) were emotionally affected by the pandemic. The fear related to the possibility of having their pregnancy affected by the virus was dominant in the group (45.8%). A high number of women (69.5%) felt safe when they accessed health services, but private hospitals were considered safer (53.1%) compared to public hospitals (14.4%). The majority of participants (53.7%) used to have prenatal care in a private healthcare system. During the pandemic, preventive measures were associated with low confidence in the healthcare system. Of the total group of participants, 123 women (22.1%) gave birth during the pandemic. Of these, a majority of the study participants considered that it was very difficult for them to cope without their partner during the hospitalization and labor period.

CONCLUSIONS

The main anxiety of pregnant women were related to threats to their lives and their baby's health because of the uncertainty caused by pandemic. It is important to know that the restrictions and the changes in maternity care had a negative impact on them. This conclusion must be taken into account when preventive measures will be decided for helping them to get through such a period. Additionally, psychological support will be essential for improving the mental health of pregnant women and for preventing a negative outcome of the pregnancy. These feelings must be taken into account when preventive measures will be established during pandemic and a psychological support will be essential for improving their mental health for preventing negative outcome of pregnancy.

Psychosocial impact of the COVID-19 pandemic on paediatric healthcare workers

Introduction: Frontline healthcare workers (HCWs) exposed to coronavirus disease 2019 (COVID-19) are at risk of psychological distress. This study evaluates the psychological impact of COVID-19 pandemic on HCWs in a national paediatric referral centre. Methods: This was a survey-based study that collected demographic, work environment and mental health data from paediatric HCWs in the emergency, intensive care and infectious disease units. Psychological impact was measured using the Depression, Anxiety, Stress Scale-21. Multivariate regression analysis was performed to identify risk factors associated with psychological distress. Results: The survey achieved a response rate of 93.9% (430 of 458). Of the 430 respondents, symptoms of depression, anxiety and stress were reported in 168 (39.1%), 205 (47.7%) and 106 (24.7%), respectively. Depression was reported in the mild (47, 10.9%), moderate (76, 17.7%), severe (23, 5.3%) and extremely severe (22, 5.1%) categories. Anxiety (205, 47.7%) and stress (106, 24.7%) were reported in the mild category only. Collectively, regression analysis identified female sex, a perceived lack of choice in work scope/environment, lack of protection from COVID-19, lack of access to physical activities and rest, the need to perform additional tasks, and the experience of stigma from the community as risk factors for poor psychological outcome. Conclusion: A high prevalence of depression, anxiety and stress was reported among frontline paediatric HCWs during the COVID-19 pandemic. Personal psychoneuroimmunity and organisational prevention measures can be implemented to lessen psychiatric symptoms. At the national level, involving mental health professionals to plan and coordinate psychological intervention for the country should be considered.

Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore

INTRODUCTION

Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore.

METHODS

Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission.

RESULTS

Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5).

CONCLUSION

The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.

COVID-19 Pandemic and Maternal Psychological Wellbeing During the Malaysian Movement Control Order: A Cross-Sectional Study

Background: COVID-19 pandemic had resulted in nationwide lockdown as a disease control measure. Potential harm to self and baby due to COVID-19 infection as well as uncertainties about delivery are among contributors to maternal anxiety. We aimed to assess the prevalence of psychological distress among pregnant women during the Malaysian Movement Control Order (MCO). Methods: A cross-sectional study was conducted between May and June 2020 in a teaching hospital in Kuala Lumpur, Malaysia. A self-administered electronic questionnaire was distributed which included the following; (1) Depression, Anxiety and Stress Scale-21 (DASS 21), (2) Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), (3) MCO effect questionnaire, and (4) newly designed COVID-19 pregnancy-related anxiety. Chi-square test and logistic regression were performed to determine significant associations whilst mean scores comparison were conducted through Mann-Whitney-U-test. Results: Four hundred and fifteen women were included in the final analysis. The prevalence of psychological distress among our cohort was 14.7%; with a two-fold increase of risk among the non-Malays (AOR 1.98, 95% CI 1.00-3.89) whilst a greater number of social support showed a protective effect (AOR 0.51, 95%CI 0.28-0.92). Malay ethnicity (p < 0.001) alongside greater household income (p = 0.014) were positive predictors of a higher sense of maternal wellbeing. Multiparous women and those of higher economic status experienced the more negative effect of the MCO. Around 88% of our women reported a higher level of COVID-19 pregnancy-related anxiety. Younger (p = 0.017) and first-time mothers (p = 0.039) were more likely to be anxious. Although adequate maternal knowledge on COVID-19 was associated with a greater sense of maternal wellbeing (p = 0.028), it was also linked to a higher level of COVID-19 related anxiety (AOR 3.54, 95% 1.29-9.70). Conclusion: There was a relatively low prevalence of psychological distress among expectant mothers in Malaysia during the first wave of the COVID-19 pandemic. Expectant mothers should receive accurate and reliable information on the effect of COVID-19 on pregnancy to relieve some maternal anxiety. Maternal health screening is important to identify individuals who would benefit from extra support and mental health intervention, especially in prolonged lockdown.

Pregnancy and Childbirth in the COVID-19 Era-The Course of Disease and Maternal-Fetal Transmission

From the beginning of the Coronavirus Disease 2019 (COVID-19) pandemic, special attention has been paid to pregnant women and to monitoring comorbidities, such as gestational diabetes and hypertension, which could increase their risk of disease and death. The purpose of this review is to synthesize the available knowledge on the course of COVID-19 in pregnant women as well as the risk of maternal-fetal transmission. The study indicated that the course of COVID-19 is worse in pregnant women who are more often admitted to intensive care units or who require mechanical ventilation than nonpregnant women with COVID-19. Some symptoms, such as dyspnea and cough, were similar to those observed in nonpregnant women, but fever, headache, muscle aches, chills, and diarrhea were less frequent. A study revealed that premature delivery and cesarean section were more common in pregnant women diagnosed with COVID-19. In addition, recent studies confirm the possibility of intrauterine maternal-fetal transmission by positive genetic tests and the presence of IgM in newborns just after delivery; at the moment, the probability of transmission through mother's milk is inconclusive. Considering all the above, a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is an important factor that threatens the health and life of both the mother and the fetus, but further studies are still needed.