Anxiety, depression, and related factors in pregnant women during the COVID-19 pandemic in Turkey: A web-based cross-sectional study

Associations of multiple risk factors with prenatal depression and anxiety: Evidence from the Tianjin Birth Cohort (TJBC) study

BACKGROUND

Antenatal mental disorders are associated with maternal and fetal adverse events. Previous studies have been focused on the postpartum period, rather than pregnancy, yet the association of risk factors with prenatal depression and anxiety through pregnancy has been rarely reported. This study aimed to identify the risk factors of prenatal depression and anxiety, and access their potential roles in developing mental disorders during pregnancy.

METHODS

This is a prospective study in 6470 participants from the Tianjin Birth Cohort in China (TJBC). The degree of prenatal depression and anxiety was evaluated using a questionnaire of Self-Rating Depression scale (SDS) and Self-Rating Anxiety Scale (SAS), which was given to pregnant women at 15-27 (Stage-2), and 28-41 (Stage-3) gestational weeks. The questionnaire also collected demographic, personal, and lifestyle information. The association of different factors with SDS/SAS score was examined by logistic regression analysis.

RESULTS

We observed an overall depression rate of 12.4 % and an overall anxiety rate of 7.7 % during pregnancy in the TJBC. In the Stage-2, the depression rate was 14.5 % and the anxiety rate was 9.5 %. In the Stage-3, the depression rate dropped to 9.7 % while the anxiety rate dropped to 5.3 %. With univariate analysis, we found that age, education, social support, marriage satisfaction, secondhand smoke (SHS), sleeping time and stress were common factors of prenatal mental health. Working status, family income, gravidity, smoking, electronic using, recreational activities were associated with depression risk, whereas BMI, disease history, changing eating habits, and feeding animal were associated with anxiety risk. Using logistic regression, we found that low education level, low social support, low marriage satisfaction, thyroid disfunction, Stage-2(second trimester), and stress were related to prenatal mental health.

CONCLUSION

The prevalence anxiety and depression in Tianjin is normal as national level. Age appropriateness, a good education level, sufficient social support, marital satisfaction, normal thyroid function, and absence of stress are associated with relieving depression and anxiety during gestation. However, due to individual difference, expectant mothers should seek professional support and guidance to address their mental health needs during gestation.

Perinatal depression and its associated risk factors during the COVID-19 pandemic in low- and middle-income countries: a systematic review and meta-analysis

PURPOSE

Perinatal depression significantly impacts maternal and child health, with further complexities arising during the COVID-19 pandemic. This review is the first to comprehensively synthesize evidence on the prevalence of perinatal depression and its associated risk factors in Low- and Middle-Income Countries (LMICs) during the pandemic period.

METHODS

The study protocol was registered in PROSPERO (CRD42022326991). This review followed the Joanna Briggs Institute (JBI) guideline for prevalence studies. A comprehensive literature search was conducted in six databases: PubMed, Scopus, Web of Science, PsycInfo, CINAHL, and ProQuest. Pooled prevalence estimates were computed for both prenatal and postnatal depression. Identified risk factors were summarized narratively.

RESULTS

A total of 5169 studies were screened, out of which 58 were included in the narrative review and 48 [prenatal (n = 36) and postnatal (n = 17)] were included in the meta-analysis. The pooled depression prevalence for prenatal women was 23% (95% CI: 19-27%), and for the postnatal women was 23% (95% CI: 18-30%). Maternal age, education, perceived fear of COVID-19 infection, week of pregnancy, pregnancy complications, and social and family support were identified as associated risk factors for depression.

CONCLUSIONS

Our review demonstrates an increased prevalence of perinatal depression during the COVID-19 pandemic in LMICs. It sheds light on the significant burden faced by pregnant and postnatal women and emphasizes the necessity for targeted interventions during the ongoing and potential future crisis.

The Stirling Antenatal Anxiety Scale (SAAS): Turkish validity and reliability study

AIMS

To examine the psychometric properties of the Stirling Antenatal Anxiety Scale (SAAS), developed by Sinesi et al., which assesses the level of anxiety of pregnant women in the prenatal period, in the Turkish culture, and to conduct a validity and reliability study.

METHODS

This study had a methodological approach, with a cross-sectional and descriptive research design. Reporting was in accordance with the STROBE checklist. The sample included 160 pregnant women who were followed up in the maternity outpatient clinics of a public hospital and a private hospital in Istanbul. Data were collected face-to-face using a personal information form, the Turkish version of the SAAS, and the Generalized Anxiety Disorder-7 scale between June and August 2023. In the data analysis, validity analyses were performed with content and construct validity and multiple fit indices for confirmatory factor analysis. Item-total score analysis was conducted using Cronbach's alpha coefficient and Pearson's correlation analysis to assess reliability. Descriptive and reliability analyses were undertaken using SPSS v.28.0.1.0, and validity analyses were performed using SPSS AMOS v.26.0.0.0.

FINDINGS

Based on expert opinions on the items in the Turkish version of the SAAS, the content validity ratio was 0.96. The decision was made to exclude Item 9 from the Turkish version because the item factor load was low. The Turkish version had a single factor, as did the original version. The Cronbach alpha coefficient was 0.87, so the Turkish version was determined to have high reliability.

CONCLUSION

The Turkish version of the SAAS, originally produced in English, has high levels of validity and reliability. In addition, it is short and easy to apply in clinical and research settings. As such, the Turkish version of the SAAS is recommended for use to evaluate the level of anxiety in pregnant women.

Heterogeneity of emotional distress in pregnancy during COVID-19 pandemic: a latent profile analysis

BACKGROUND

Emotional distress, including depressive and anxiety symptoms, is a common concern among pregnant individuals and has negative impacts on maternal and offspring's health. Previous studies indicated the heterogeneity of perinatal emotional distress. Moreover, during the pandemic of COVID-19, expectant mothers are faced with more tough challenges, which could exacerbate their emotional distress.

OBJECTIVE

The aim of present study is to examine potential subgroups with distinct profiles on emotional distress and relationship resources during the pandemic.

METHODS

A total of 187 pregnant people in China were recruited from April 22 to May 16 in 2020. Latent profile analysis was applied based on prenatal depressive and anxiety symptoms, COVID-19-related negative emotions, prenatal attachment, marital satisfaction and family sense of coherence.

RESULTS

Four subgroups were identified. Group 1 and Group 2 shared with low levels of emotional distress and COVID-19-related negative emotions, among which Group 1 had plenty of relationship resources, while Group 2 had insufficient support. Group 3 had moderate levels of emotional distress but above-average prenatal attachment. Group 4 was a highly distressed subtype with severe emotional distress and poor states across all domains.

CONCLUSION

Our findings support that emotion distress among expecting mothers is heterogeneous, highlighting the need for tailed interventions to address the specific needs of subgroups during pregnancy.

Coronavirus Disease 2019 Pandemic-Related Long-Term Chronic Impacts on Psychological Health of Perinatal Women in China

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic has caused far-reaching changes in all areas of society. However, limited data have focused on the long-term impacts on perinatal psychological health. This study aims to evaluate long-term impacts of COVID-19 pandemic crisis on psychological health among perinatal women and investigate associated factors.

STUDY DESIGN

A multicenter, cross-sectional study, the psychological subproject of China Birth Cohort Study (CBCS), was conducted in 2021. Demographic and obstetric characteristics, pregnancy outcomes, psychological status, and COVID-19-pandemic-related factors were obtained. The symptoms of depression, anxiety, and insomnia of participants were assessed by Patient Health Questionnaire, Edinburgh Postpartum Depression Scale, Generalized Anxiety Disorder Scale, and Insomnia Severity Index, respectively. Multivariate logistic regression was used to identify associated factors of adverse psychological symptoms.

RESULTS

Totally, 1,246 perinatal women were enrolled, with the overall prevalence of depression, anxiety, and insomnia symptoms being 63.16, 41.89, and 44.38%, respectively. Perinatal women who needed psychological counseling and were very worried about the COVID-19 pandemic were 1.8 to 7.2 times more likely to report symptoms of depression, anxiety, and insomnia. Unemployment, flu-like symptoms, younger maternal age, and previous diseases before pregnancy were risk factors for depression, anxiety, or insomnia.

CONCLUSION

Our study revealed that the prevalence of perinatal depression, anxiety, and insomnia symptoms was at a high level even 1 year after the pandemic outbreak, implying pandemic-associated long-term psychological impacts on perinatal women existed. Government should not only pay attention to the acute effects of psychological health but also to long-term psychological impacts on perinatal women after major social events.

KEY POINTS

· The prevalence of perinatal psychological symptoms was at a high level after the COVID-19 outbreak.. · Perinatal women who were very worried about COVID-19 were more often to have psychological symptoms.. · Perinatal women with demands of mental counseling were more likely to report psychological symptoms..

Does COVID-19 anxiety in pregnant women affect marital adjustment?

In this study, it was tried to determine the relationship between anxiety and marital adjustment in pregnant women during the epidemic, and to explain the variables affecting anxiety and marital adjustment. During the epidemic, many factors cause changes in the perceived anxiety level and marital adjustment in pregnant women. As the level of COVID-19 anxiety increases in pregnant women, marital adjustment scores decrease. It was determined that the anxiety levels were lower and marital adjustment was higher in pregnant women who had a planned pregnancy, did not have fears about childbirth, thought that their physical, mental health were not affected.

Being a Mother under the COVID-19 Pandemic Lockdown: Evaluation of Perinatal Anxiety, Prenatal Attachment, and Maternal-Infant Attachment

OBJECTIVES

The novel coronavirus disease 2019 (COVID-19) pandemic has caused both physical and emotional stress throughout the population due to its worldwide impact. The unknowns about the disease, social isolation, pregnant women's concerns regarding exposure to the COVID-19, inaccessibility to necessary care, and the possibility of harm to their fetus may cause increased psychological distress during the perinatal period. We aimed to evaluate the association between perinatal anxiety, prenatal attachment, and maternal-infant attachment status among women with those who delivered their child in a tertiary-care center with rigid hospital restrictions.

STUDY DESIGN

Term pregnant women who experienced the last trimester of their pregnancy during COVID-19 curfews between December 2020 and May 2021 were asked specifically about their concerns during the COVID-19 pandemic and they filled out the Perinatal Anxiety Screening Scale (PASS) and the Prenatal Attachment Inventory (PAI). Those who continued the follow-up within a month of period following the delivery were invited to fill out the Maternal Attachment Inventory (MAI).

RESULTS

A total of 600 women completed the survey. While the evaluation of the relationship between participants' mean PAI and MAI scores showed a statistically significant positive correlation between scales (r = 0.124, p = 0.002), mean PAI and PASS scores showed a statistically significant negative correlation between scale scores (r = - 0.137, p = 0.001).

CONCLUSION

Examining the factors, affecting the attachment process of pregnant and puerperal women, will guide the improvement of the quality of health services in the COVID-19 pandemic.

KEY POINTS

· COVID-19 caused psychological distress, with increased anxiety among perinatal women.. · Elevated levels of anxiety about COVID-19 during pregnancy may lead to insecure attachment.. · Insecure attachment in the prenatal period will negatively contribute to mother - infant attachment..

Study protocol for improving mental health during pregnancy: a randomized controlled low-intensity m-health intervention by midwives at primary care centers

BACKGROUND

Pregnancy-related anxiety and depression has received considerable attention worldwide. Mental health problems in pregnant women already since early weeks of gestation may have important consequences to the fetus. The necessity for more effective health care pathways, including some early interventions that reduce the overall burden of the childbearing situation appears a key factor for a successful birth and care of the baby. The few studies focalized in interventions, are focused on delivery and postpartum, without taking into account the whole maternity process. Current literature recommends the use of interventions based on new technologies for the treatment of mood disorders, already during the prenatal period. There have been scarce well-designed intervention studies that test technological low-intensity interventions by midwives to address pregnant women's mental health, diminishing anxiety and depression during pregnancy.

METHODS/DESIGN

Adult pregnant women (weeks 12-14 of gestation) will be recruited and screened from different primary care centers in Catalonia, Spain. Women who pass the initial mental screening will be randomly allocated to the relaxation virtual reality intervention or control group. The intervention aims to improve mental state of pregnant women during pregnancy, work through breathing, mindfulness and muscle relaxation techniques. Women in the control group will receive standard care offered by the public funded maternity services in Catalonia. The primary outcome measures will include the Edinburg Postnatal Depression (EPDS), State Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), and the Cambridge Worry Scale (CWS) instruments. Secondary outcome measures will include the Temperament and Character Inventory-Revised (TCI-R) and the Whooley and Generalized Anxiety Disorder-2 (GAD-2) questions. Routinary pregnancy monitoring measures will be also evaluated.

DISCUSSION

This study aims to test the efficacy of a low-intensity, midwife-led e-health intervention based on new technologies to work on women's anxiety and depression during pregnancy. We hypothesize that low-intensity mental health intervention during pregnancy, using an e-health (virtual reality) as a support tool, will be effective in reducing of anxiety, depressive symptoms, and improving satisfaction with pregnancy follow-up.

TRIAL REGISTRATION

Clinical Trials ID NCT05756205.

Pregnancy school education program in mother friendly training and research hospital impact on stress and anxiety

OBJECTIVE

This study aimed to investigate prenatal education and its relationship with anxiety and stress in pregnant women.

METHODS

This research was carried out between July 1, 2022, and December 1, 2023, at Giresun Gynecology and Pediatrics Training and Research Hospital. Women aged >18 years at >20 weeks of pregnancy were included. Patients were randomized into two groups, and one group received a 4 week training on meditation, breathing exercises, and pregnancy-related health issues. A questionnaire was applied to both groups to analyze sociodemographic characteristics, pregnancy, birth, medical history, the Pregnancy Stress Rating Scale, and the State Trait Anxiety Inventory.

RESULT

The groups were similar in terms of age, educational status, anthropometric characteristics, occupation, economic status, and gestational week. There was no difference between the trained and nontrained groups in terms of the Pregnancy Stress Rating Scale score and the State Trait Anxiety Inventory-state score. The State Trait Anxiety Inventory-trait was significantly lower in the trained group (p=0.033). There were weak positive correlations between Pregnancy Stress Rating Scale score and medication use and between State Trait Anxiety Inventory-state score and age. A negative correlation was found between the State Trait Anxiety Inventory-state score and working status, showing that employed women had lower anxiety scores irrespective of training. Another weak positive correlation was found between the State Trait Anxiety Inventory-trait score and the presence of comorbidities.

CONCLUSION

State Trait Anxiety Inventory-trait anxiety was lower in pregnant women who received training on prenatal meditation, exercise, and pregnancy health; however, State Trait Anxiety Inventory-state and Pregnancy Stress Rating Scale scores were similar in the two groups. Unemployed pregnant women and those with chronic diseases appear to need closer follow-up to reduce anxiety levels.

The impact of the second COVID-19 lockdown on anxiety and depressive symptoms in pregnant women: A case study of pregnant women in northern Italy

Background

the different lockdown phases due to COVID-19 may have negatively impacted pregnant women's mental health. Concerning antenatal stress, most studies focused more on the effect of pandemic onset than on the impact of the following phases and restrictions.

Aim

the present study aimed to assess levels of anxiety and depression in a group of Italian pregnant women during the second COVID-19 phase and possible risk factors.

Method

We recruited 156 pregnant women through our Perinatal Psychology Outpatient Clinic. We divided the sample into women recruited before the pandemic (N = 88) through a face-to-face antenatal class and pregnant women recruited during the second lockdown (Covid-19 study group) (November 2020-April 2021) through the same antenatal class via Skype (N = 68). To investigate depressive and anxiety symptoms, we administered the Edinburgh Postnatal Depression Scale (EPDS) and the State and Trait Anxiety Inventory (STAI-Y) scales; women's medical history and obstetric data were collected.

Findings

women belonging to the Covid-19 study group reported higher depressive and anxious levels than the pre-pandemic group. Moreover, during the second lockdown previous psychopathology and being close to childbirth were related to increased depression; a history of abortion was related to higher levels of trait anxiety instead.

Conclusion

recurrent restrictive measures due to COVID-19 negatively affected the antenatal mental well-being of pregnant women, particularly worsening depressive and anxious feelings. Pregnant women during the pandemic represented a vulnerable population to be monitored more closely and timely to prevent psychological problems in the postpartum period and their consequences on the child.

Keywords

anxiety, depression, pregnancy, COVID-19, mental health, lockdown.

Perinatal depression during the fourth wave of the COVID-19 outbreak in a single prenatal clinic in Southern Italy: The role of loneliness, anxiety, and maternal support

Background

The current study aimed at assessing the levels of perinatal depression (i.e., both antenatal and postnatal) during the fourth wave of the COVID-19 outbreak in a group of Italian women, as well as to evaluate the role of loneliness, anxiety, and lack of maternal support in cumulatively predicting perinatal depression.

Methods

A cross-sectional study was conducted with 200 Italian women recruited during a peak of the COVID-19 pandemic in Italy (i.e., from September to December 2021) from a single prenatal clinic in Southern Italy. A non-parametric binomial test was conducted to assess whether the perinatal depression frequencies of the current sample differed from those found in a pre-Covid reference group. Additionally, hierarchical multiple linear regression analyses assessing whether loneliness, anxiety, and maternal support affected women's perinatal depression were also conducted.

Results

The general prevalence of perinatal depression was significantly higher in participants recruited during the fourth wave of the COVID-19 pandemic compared to the pre-Covid reference group (29% vs. 9.2%). However, results showed that, contrary to postnatal depression (18.2% vs. 19.9%), only the prevalence of antenatal depression was significantly higher compared to the pre-Covid reference group (39.6% vs. 6.4%). Furthermore, loneliness and anxiety, but not maternal support, were associated with higher levels of PD.

Limitations

Limitations concerned the cross-sectional nature of the study and the relatively small sample size.

Conclusions

This study sheds light on the need to address perinatal mental health of women during major stressful events, such as the COVID-19 pandemic.

Need Asseesment on Maternal Mental Health Care for Perinatal Mothers during COVID-19: A Qualitative Study

Background

During COVID-19 pandemic, the isolation, socialization, and extreme changes in daily life have some potential mental health consequences which should be recognized as a critical public health concern, especially for perinatal mothers. Therefore, it is very important to assess the needs for maternal mental health care in perinatal mothers during COVID-19 pandemic. This study aimed to explore mothers' needs for maternal mental health care in the perinatal period during COVID-19 pandemic.

Material and Methods

Realistic phenomenological approach was carried out in this qualitative study. The study was conducted at five community health centers in the city of Tangerang, Indonesia. In-depth interviews were conducted to 11 mothers who were pregnant, in labor, during puerperium and two months after giving birth with purposive sampling. Data were collected from May to August 2021. Interviews were conducted face to face, audio recorded, and transcribed verbatim. Data were analyzed by using Van Manen's phenomenological method.

Result

Initial finding revealed 254 codes, which were then reduced to 122 codes, 98 sub-categories, 22 categories, and 5 themes. There were five themes related to mothers' needs for mental health care during COVID-19, i.e., health protocol during pandemic, psychological support, health education, simple coping mechanism, and support system.

Conclusions

The needs can be fulfilled by the closest people the mothers have and healthcare system for perinatal mental health. Vaccination, health protocol, and psychological resilience should be delivered to mothers during COVID-19.

The socio-demographic profile associated with perinatal depression during the COVID-19 era

BACKGROUND

Coronavirus disease 2019 (COVID-19) has caused an increase in perinatal depression. The aim of this research was to identify which sociodemographic variables are related to the increase in perinatal depression due to the pandemic. In addition to estimating to what extent they predict perinatal depression, differentiating the prenatal and postnatal periods.

METHODS

The sample consisted of 3,356 subjects, 1,402 in the prenatal period and 1,954 in the postnatal period. The Edinburgh Postnatal Depression Scale was used to assess depressive symptomatology. A subset of 14 questions was included to collect demographic data. Items from the Spanish version of the Coronavirus Perinatal Experiences Survey were also included.

RESULTS

Experiencing the change of environment due to COVID-19 as negative and having a history of mental health predict perinatal depression, otherwise having higher education decreases the risk. In the prenatal stage having symptoms compatible with COVID-19 is a predictor of perinatal depression and having more than 3 years living together with the partner and being a housewife decreases the risk. In the postnatal stage being unemployed is a predictor of prenatal depression and being a first-time mother decreases the risk.

CONCLUSIONS

This study highlights the relevance of sociodemographic status. It is essential to be aware of the risk factors of perinatal depression, to make adequate prevention, and to create health policies to alleviate the consequences of the pandemic.

COVID-19 anxiety and quality of life among adolescent pregnant women: a cross-sectional study

OBJECTIVES

To determine the relationship between the COVID-19 anxiety and the quality of life among adolescent pregnant women in Dashtiari city, Iran.

METHODS

In this cross-sectional study, 216 adolescent pregnant women in Dashtiari city, Iran in 2021 who met the inclusion criteria participated in a multi-stage sampling. Data collection tools included: demographic information, COVID-19 Anxiety Scale and a questionnaire of quality of life. Finally, the obtained data were analyzed in SPSS software version 21 using descriptive, Chi-square, Tukey and logistic regression tests.

RESULTS

The results showed that 74 (34.3%) adolescent pregnant women had weak COVID-19 anxiety, 23 (10.6%) had moderate COVID-19 anxiety and 119 (55.1%) had severe COVID-19 anxiety. The results also showed that gestational age (OR=2.2, p=0.03), history of COVID-19 infection among adolescent pregnant women (OR=1.6, p=0.02), history of family and friends (OR=1.7) (p=0.04), quality of life (OR=4.3, p=0.001), increases the probability of COVID-19 anxiety.

CONCLUSIONS

Considering the psychological consequences of the post-COVID-19 era and the psychological events that occur in this period, by identifying and predicting these issues, strategies should be considered for optimal intervention and reduction of injuries in the post-crisis era.

Evaluation of the association between fear of COVID-19 and pregnancy distress

Background

Mental health problems experienced during pregnancy negatively affect both maternal and fetal wellbeing.

Objective

This study aimed to investigate the relationship between fear of COVID-19 and pregnancy distress in healthy pregnant women living in Turkey.

Methods

A descriptive, relational/cross-sectional study was conducted by interviewing 363 pregnant women in person. Data were collected using a personal information form, the Fear of COVID-19 Scale (FCV-19S), and the Tilburg Pregnancy Distress Scale (TPDS).

Results

The mean FCV-19S score was 19.03±5.65 and the mean TPDS score was 19.97±7.97. According to the TPDS cut-off score, 19.0% of the participants were at risk of pregnancy distress. There was a significant positive correlation between FCV-19S and TPDS scores (r = 0.263, p<0.05). According to the regression analysis, age (β= -0.217), years of education (β= -0.272), and number of births (β= 0.502) were associated with fear of COVID-19, and fear of COVID-19 was associated with TPDS scores (β= 0.369) (p<0.05).

Conclusion

The pregnant women in this study had moderate fear of COVID-19. Compared to the literature data, the prevalence of pregnancy distress was slightly higher than pre-COVID-19 reports but quite low compared to other studies conducted during the pandemic.

Impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices: a global scoping review

BACKGROUND

In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), generating stark economic and social repercussions that directly or indirectly affected families' wellbeing and health status.

AIMS

This review aims at mapping the existing evidence on the impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices, worldwide, to identify evidence gaps and better inform future delivery of care and health policy measures.

METHODS

Following the protocol defined by PRISMA-ScR, this scoping review has searched for relevant studies published between January 2020 and June 2021, selecting evidence sources based on pre-established criteria. From a total of 2,308 articles, data were extracted from 537 publications from 35 countries on all three health domains.

RESULTS

The combined stressors brought forth by the pandemic have exerted a heavy burden on the mental health of mothers and the development of young children, partly mediated by its impact on parental practices.

CONCLUSIONS

Despite remaining gaps, we have identified sufficient evidence pointing to an urgent need for more concerted global research efforts and rapid policy responses to timely address severe and pervasive negative impacts to the mental health of mothers and children at a key developmental stage.

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.

The Impact of the COVID-19 Pandemic on the Level of Physical Activity, Emotional State, and Health Habits of Women in Late Pregnancy and Early Puerperium

The aim of the study was to determine the impact of the Covid-19 pandemic on the level of physical activity in the last trimester, the risk of developing postnatal depression, and general health habits in late pregnancy and the early postpartum period.

METHODS

The study population was women 1-8 days postpartum. Participants were divided into three groups depending on when they were recruited: (1) prepandemic (Ppan: n = 252, December 2019-March 2020), (2) COVID1 group (Cov1: n = 262, May 2020-September 2020), and (3) COVID2 group (Cov2: n = 226, June 2021-September 2021). The Ppan group included women from before the pandemic. The Cov1 group included patients after some restrictions were lifted. The Cov2 group included women after vaccinations became available. Research tools included a demographical questionnaire (age, education, childbirth details), the Pregnancy Physical Activity Questionnaire (PPAQ), the Edinburgh Postnatal Depression Scale (EPDS), and the Health Behavior Inventory (IZZ).

RESULTS

Regression analysis showed that regardless of other variables, women who gave birth during the pandemic spent less energy on total physical activity compared to the prepandemic group (Cov1: β = -18.930, 95%CI: -36.499 to -1.361; Cov2: β = -26.527, 95%CI: -44.322 to -8.733). We also found that as the risk of depression increased, engagement in general health habits decreased during the pandemic.

CONCLUSIONS

The Covid-19 pandemic decreased the level of some subdomains of physical activity in pregnant women, with a general negative correlation between emotional state and healthy habits.

Trauma-informed care for perinatal women during the COVID-19 pandemic: A survey of nurses and midwives in Turkey

OBJECTIVES

There is a paucity of evidence on the provision of trauma-informed care among nurses and midwives during the pandemic.Therefore, this online survey of Turkish nurses and midwives aimed to: describe reported maternal concerns and anxieties during the COVID-19 pandemic; and explore aspects of trauma-informed care for perinatal women during the COVID-19 pandemic (i.e., nurses' and midwives' knowledge, opinions, perceived competence, current practices, and implementation barriers).

DESIGN

A cross-sectional descriptive survey design.

SETTING AND PARTICIPANTS

A web-based survey conducted between June 2021 to December 2021. A total of 102 nurses and midwives comprised the final sample of this study.

FINDINGS

The safety of COVID-19 vaccine was both the most common maternal concern (73%) and the most frequently noted maternal source of anxiety (79%) reported to nurses and midwives by perinatal women. Most nurses and midwives were knowledgeable of, held favorable opinion about, and perceived moderate competence in trauma-informed care. The most frequently provided practice was encouraging mothers to make use of their own social support system (82%). Time constrains and lack of resources were perceived as somewhat to significant barriers to providing trauma-informed care during the pandemic.

CONCLUSIONS

Access to correct information related to COVID-19 vaccination is necessary to reduce maternal anxiety. Since perinatal nurses and midwives had favorable opinions concerning implementing trauma-informed care, successful strategies for mitigating the implementation barriers are essential to facilitate the provision of trauma-informed care during the pandemic.

Can we hit prenatal depression and anxiety through HIIT? The effectiveness of online high intensity interval training in pregnant women during the COVID-19 pandemic: a randomized controlled trial

BACKGROUND

In recent years high intensity interval training (HIIT) has grown in popularity. However, it rarely represents training interventions in experimental studies in pregnant populations. Therefore, in this study we aimed to assess changes in depressive symptoms, fear of childbirth, fear of Covid-19 and quality of life after an 8-week supervised online HIIT program, compared to an educational (self-performed physical activity) program.

METHODS

We conducted a randomized control trial among 54 Caucasian women in uncomplicated, singleton pregnancy (age 32 ± 4 years, 22 ± 4 week of gestation; mean ± SD). There were 34 women in the experimental group, who participated in an 8-week high intensity interval training program (HIIT group). The comparative group was constituted of 20 pregnant women who attended 8-week educational program (EDU group).

RESULTS

The most important finding was that mental health improved somewhat in both groups after the intervention, but only the HIIT group improved statistically significantly. The positive trends in lowering the severity of depressive symptoms, fear of childbirth, and fear of Covid-19 were observed in both groups. However, the positive response to the intervention was stronger in the EDU group. As a secondary outcome, there was a significant decrease in cardiorespiratory fitness level in the EDU group, while the HIIT group maintained unchanged level of maximal oxygen uptake.

CONCLUSIONS

HIIT seems to be beneficial for women with uncomplicated pregnancies to maintain adequate quality of life and mental health. However, more research is needed to determine the effectiveness of prenatal HIIT in pregnant women in various psychological conditions.

TRIAL REGISTRATION

We conducted this study in Poland, in 2021. It was approved by the Bioethics Commission at the District Medical Chamber in Gdansk (KB-8/21). The full study protocol was registered in ClinicalTrials.gov (NCT05009433).

Postpartum depression crisis since the second lockdown and 'screening paradox': many women identified, very few treated

OBJECTIVE

Exposure to stressful situations, such as emergencies, infectious diseases, and natural disasters, may lead to a heightened risk of perinatal mental health problems. Declared on March 11th, 2020, the global COVID-19 pandemic triggered an additional burden on women in the perinatal period. Safety recommendations, such as social distancing and isolation, were opposite to the usual advice given to new mothers. Besides fear, changes in financial stability and daily life reorganization contributed to increased depressive symptoms. As the periods of epidemic waves and lockdowns were associated with a more significant burden for young families, we aimed to assess the intensification of depressive and anxiety symptoms during the pandemic concerning the time intervals of the three lockdowns introduced in Poland.

METHODS

1588 postpartum women took part in the online self-assessment with the Edinburgh Postnatal Depression Scale (EPDS) and General Anxiety Disorder 2 (GAD-2) questionnaire between January 1, 2020, and March 31, 2021. This self-screening is a part of a prevention program The Next Stop: Mum, implemented in the North of Poland.

RESULTS

The highest severity of PPD symptoms and anxiety were observed during the second lockdown in Poland: the mean score in the EPDS and anxiety assessment was significantly higher than the mean scores from previous pandemic periods. Since the second lockdown, the average EPDS and GAD-2 scores remained similarly high. Moreover, with the duration of the COVID-19 pandemic, the percentage of women with elevated symptoms of postpartum depression and anxiety began to increase. However, the Polish National Health Fund data indicate that only 0,7% of women giving birth in the northern macro-region of Poland received diagnosis and help from public funds. In The Next Stop: Mum project, 250 women benefited from psychological consultations.

CONCLUSION

Increased severity of depression and anxiety symptoms during the pandemic indicates the need for additional psychological support for postpartum women. However, very few women are diagnosed in health facilities in the first year postpartum and thus are rarely referred for further treatment. The study shows that the availability of services and the focus on social and individual barriers may be critical factors in implementing perinatal mental health programs and practices. This may be especially needed in a country where the screening obligation is new. In case of a further pandemic, policymakers and health care professionals should be aware that the duration of the restrictions and the repetition of lockdowns are associated with the aggravation of symptoms. The online screening without the possibility to discuss the results is only partially effective in increasing referrals for possibly affected women.

The effect of pregnant women’s health-seeking behavior and preference for mode of birth on pregnancy distress during the COVID-19 pandemic

In this study, the researchers investigated to the impact of pregnant women's health-seeking behavior and mode of birth preferences on pregnancy distress during the COVID-19 pandemic. This study was conducted with 351 pregnant women. The risk rate of pregnancy distress using the Tilburg Pregnancy Distress Scale (TPDS) cut-off point was 16.5%. 13.3% of pregnant women changed their mode of birth preferences due to the pandemic. The risk of pregnancy distress in women who changed their mode of birth preferences due to the pandemic increased 5.4 times more than in those who preferred vaginal birth before and during the pandemic (OR: 5.4, p<0.001). We determined that the increase in the Health Seeking Behavior Scale total scores had a reducing effect on pregnancy distress due to a lack of partner involvement for TPDS.

The Effects of the COVID-19 Pandemic on Clinical and Laboratory Follow-up of Patients Diagnosed With Chronic Hepatitis B: A Multicenter, Prospective, Observational Study

Background: Chronic hepatitis B (CHB) patients who are under the treatment of antiviral agents should be monitored in routine control visits. However, during the COVID-19 pandemic, the visits were interrupted. Objectives: This study aimed to investigate whether these patients were affected regarding clinical, laboratory, and treatment outcomes. Methods: This prospective study consisted of CHB patients aged > 18 who were applied to 3 tertiary centers between 14 February and 30 March 2022. The patients were selected from the ones who regularly applied to outpatient clinics and under the treatment of antiviral agents before the pandemic. The demographic and laboratory values, including serologic, biochemistry, and molecular results, were compared between the 2 groups who came and did not come to control visits. Results: A total number of 220 patients were included. More than half (n = 142, 64.5%) were female. The median age was 44 years (19 - 73). A hundred and forty-two (64.5%) patients did not come to control visits during the pandemic. The most common reason was anxiety about COVID-19. The tenofovir treatment was replaced with entecavir (ETV) due to osteopenia and with alafenamide due to osteopenia and/or renal failure. The previous agents were re-started in 27 (79.5%) patients who discontinued the treatment. Conclusions: The COVID-19 pandemic negatively impacted the follow-up of CHB patients. In this regard, 15.5% of patients stopped their treatments. The patients who stopped their follow-ups and continued tenofovir disoproxil fumarate (TDF) had proteinuria and decreases in bone mineral density (BMD) and estimated glomerular filtration rate (eGFR) levels.

Impact of COVID-19 on perinatal mental health among pregnant mothers infected with COVID-19, during the first wave of the epidemic in Jordan

Background

Data concerning the impact of Coronavirus disease (COVID-19) infection on the mental health of pregnant women are still limited. The study explored baseline information regarding the impact of COVID-19 on mental health in the perinatal period, among mothers infected with COVID-19, during the first wave of the epidemic in Jordan. The current study aimed to examine the anxiety levels of pregnant women infected with coronavirus over the COVID-19 pandemic.

Methods

A cross-sectional study was conducted during the period from March to December 2021, using an online survey that addressed key issues related to the role of COVID-19 infection in developing anxiety among pregnant women using the Edinburgh Postnatal Depression Scale (EPDS). The study population was pregnant women with laboratory-confirmed COVID-19 infection, and who agreed to participate in the study (n = 530).

Results

The results indicated that one-third of the women had contracted coronavirus infection in each trimester. Most had no pregnancy complications (78.0%), 42.0% had no symptoms of coronavirus infection, 10.0% were hospitalized and 2.0% were admitted to the Intensive Care Unit (ICU). Approximately half declared that they did not receive support from the medical staff, although 71.0% had very good support from their families. Nearly a quarter of respondents stopped smiling while infected, 19% did not want to have any entertainment, and one-third had sleep problems. Moreover, more than half of the pregnant women were feeling anxiety (58.0%) and fear (59.0%). The prevalence of depression and anxiety was 67%. The EPDS scores were statistically significant and associated with being a smoker, method of delivery, getting COVID-19, experiencing COVID-19 symptoms, and being admitted to a hospital or ICU.

Conclusions

This study highlights that healthcare providers and family members should pay more attention to maternal mental health during a pandemic. Fear and anxiety among pregnant women need to be taken into account more during the period of international crises, taking into account the mental health of the pregnant woman when developing health plans, developing health programs, and providing diagnostic and therapeutic management in the maternal care departments.

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.

Individual Characteristics and Pain Sensitivity during Pregnancy-A Cross-Sectional Study in Pregnant and Non-Pregnant Women

The aim of the study was to describe the characteristics and factors related to pain perception in pregnant women, such as optimism, personality traits, and fear of developing COVID-19 consequences. Sixty-six pregnant women aged 23 to 42 years participated in the study, and the comparison group consisted of n = 59 non-pregnant female students aged 19 to 23 years. Pressure pain threshold and pain tolerance were measured with an algometer. To assess psychological characteristics, the Life-Orientation Test-Revised was used to assess optimism, the Fear of COVID-19 Scale was used to assess COVID-19 anxiety, and the Ten-Item Personality Inventory was applied to assess personality traits in a five-factor model. The main results of the study showed that pain tolerance was significantly lower in both dominant and non-dominant hand pregnant women than in the comparison group. The studied pregnant women had higher scores for conscientiousness, fear of COVID-19, and optimism compared with the non-pregnant women. Regression analysis showed that the variability in pain perception among pregnant women could not be explained by individual differences in personality traits, optimism, and fear of COVID-19.

Psychosocial outcomes of the COVID-19 pandemic on pregnant women

The aim of this study was to compare the levels of anxiety and social support evaluated in pregnancy before and during the COVID-19 pandemic. This study was designed prospectively and observationally. Participants were asked to fill in two different questionnaire forms for the Multidimensional Scale of Perceived Social Support and The State-Trait Anxiety Inventory. Independent t-test and Pearson correlation analysis were used for statistical analysis. The mean age of 386 pregnant was 29.1 ± 4.91 years, and the gestational week was 29.12 ± 4.54. The values of the total social support scale were determined 61.52 ± 5.53-51.15 ± 5.86 before and during the pandemic, while the total state anxiety scale was found 39.81 ± 9.04 and 63.38 ± 10.55, respectively. The total trait anxiety scale was found at 38.23 ± 7.39 and 53.22 ± 8.74 in the same respect. A significant difference was obtained in the data between before and during the pandemic (p < .05). The study showed that pregnant are deprived of social support and their anxiety levels increase during the COVID-19 pandemic.IMPACT STATEMENTWhat is already known on this subject? During the COVID-19 pandemic, the prevalence of depression and anxiety in pregnant women have been reported as 25.6 and 30.5%, respectively. Social support is an important determinant of physical and psychological well-being, especially during pregnancy when individuals take on new responsibilities and roles.What do the results of this study add? The study showed that pregnant women were deprived of social support and their anxiety levels increased during this pandemic. The results highlight that there is a high need to mitigate mental health risks and adjust interventions under pandemic conditions.What are the implications of these findings for clinical practice and/or further research? It is necessary to provide social support from family, friends, and close circles. States and health professionals need to put forward serious programs and studies to reduce the stress and anxiety experienced by the society and especially pregnant women and to provide accurate information about COVID-19.

Physical activity before and during pregnancy and maternal mental health: A systematic review and meta-analysis of observational studies

OBJECTIVE

To examine the influence of physical activity before and during pregnancy on maternal mental health outcomes.

METHODS

Ten electronic databases were searched up to May 11, 2021. Studies of all observational designs (except case studies and reviews) were included, which contained information on the relevant population (women before and or during pregnancy), exposures (objective or subjective measures of physical activity), comparator (low or no physical activity), and outcomes (diagnosis and symptom severity of depression or anxiety, quality of life scores, stress and emotions).

RESULTS

Forty-four observational studies (N = 132,399) were included. 'Low' to 'very low' certainty evidence revealed that compared with low levels of PA during pregnancy, high levels of PA were associated with a reduced odds of developing prenatal depression (odds ratio (OR): 0.68, 95% confidence interval (CI): 0.58 to 0.80) and anxiety (OR: 0.67, 95% CI: 0.54 to 0.83). We also found a reduction in the severity of prenatal depressive symptoms (standardized mean difference (SMD): -0.37, 95% CI -0.57 to -0.17), prenatal anxiety symptoms (SMD: -0.45, 95% CI -0.64 to -0.27), and prenatal stress (SMD: -0.33, 95% CI -0.55 to -0.11), concurrent with improved quality of life (SMD: 0.38, 95% CI 0.23 to 0.54). PA before pregnancy did not impact the outcomes of interest.

CONCLUSION

Physical activity during pregnancy is associated with a reduction in the odds and severity of prenatal depression and anxiety, as well as reduced stress and improved quality of life. PROSPERO registration number: CRD42020208469.

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.

The Relationship between Fear of Covid-19, Anxiety and Depression in Pregnant Women

Purpose: The aim of the study was to investigate the relationship between coronavirus disease-19 (COVID-19) fear, anxiety and depression on pregnant women. Methods: The cross-sectional, correlational research was conducted with 335 pregnant women from June to October 2020 at the antenatal outpatient clinics of a university hospital. Data were collected using Description Form, Fear of COVID-19 Scale (FCV-19S), Beck Anxiety Inventory (BAI) and the Edinburgh Postnatal Depression Scale (EPDS). Results: The FCV-19S, BAI and EPDS average scores were 21.12±6.56, 6.39±5.48 and 8.13±9.13, respectively, indicating pregnant women' levels of COVID-19 fear were moderately high and their anxiety and depression levels were moderate. Overall, 14.0% of pregnant women had depression risk and 42.4% had symptoms of anxiety (26.3% low level, 10.4% moderate level and 5.7% high level). A positive, significant relationship was found between the COVID-19 fear level and depression (r=0.207, p

Factors associated with prenatal stress and anxiety in pregnant women during COVID-19 in Spain

AIM OF THE STUDY

To describe prenatal stress and state anxiety levels in pregnant women living in Spain during the lockdown of the first wave of COVID-19 and its relation with obstetric factors, perception of health care, and concerns about the socio-sanitary situation.

METHODS

The present study is an observational, correlational, and cross-sectional quantitative study. The participants in the study were pregnant women recruited through non-probabilistic convenience and snowball sampling during the lockdown. A web link was provided to an online questionnaire designed for this research, which collected socio-demographic and obstetric variables, perceptions of health care received during the pandemic and preoccupations associated with COVID-19. It also included the Prenatal Stress Questionnaire (PDQ) and the State Anxiety Inventory (STAI-S).

RESULTS

Based on the responses of 695 pregnant women, the results showed a mean of 16.98 (SD = 25.20) of prenatal stress and elevated levels of anxiety (M = 25.20/SD = 11.07) in the first wave of the pandemic. Risk factors for prenatal stress and anxiety were the level of preoccupation associated with COVID-19 and previous mental health issues. A specific risk factor for anxiety was having more than one child and a protective factor were perceiving accessibility and availability of health care, with clear and consistent pregnancy care and follow-up protocols.

CONCLUSIONS

The lockdown period for COVID-19 was a stressful experience for pregnant women, highlighting the need to address their psychological well-being through clear and coherent protocols in terms of maternal-foetal health control and follow-up.

Physical Health, Media Use, Stress, and Mental Health in Pregnant Women during the COVID-19 Pandemic

Background: The COVID-19 pandemic has led to significant changes in the care of pregnant women and their fetuses. Emerging data show elevated depression and anxiety symptoms among pregnant women. Aims: The purpose of this article is to investigate the psychological and behavioral impact of the COVID-19 pandemic on pregnant women in Greece during the first national lockdown. Methods: We used a cross-sectional, anonymous survey to collect data in two fetal medicine clinics in the largest urban centers of Greece during the months of April and May 2020. The questionnaire was largely based on the CoRonavIruS Health Impact Survey (CRISIS), and assessed sociodemographic characteristics, general health and obstetric data and COVID-19-related worries and life changes. Mood symptoms, substance use and lifestyle behaviors were assessed at two time points (3 months prior to the pandemic and the 2 weeks before taking the survey), while perceived stress was measured with the perceived stress scale (PSS-14). Results: A total of 308 pregnant women (Mage = 34.72), with a mean gestation of 21.19 weeks participated in the study. Over one-third of the women found COVID-19 restrictions stressful, and their highest COVID-19-related worry was having to be isolated from their baby. Mean PSS-14 score was 21.94, suggesting moderate stress. The strongest predictors of stress were physical and mental health status before COVID-19 and having experienced a stressful life event during their pregnancy. Compared to 3 months before the pandemic, women reported higher scores on mood symptoms (p < 0.001), TV use (p = 0.01) and social media use (p = 0.031) in the last 2 weeks before taking the survey. Conclusion: Our study provides important preliminary evidence of the negative impact of the COVID-19 pandemic and the lockdown on pregnant women’s well-being and functioning.

[Factors associated with prenatal stress and anxiety in pregnant women during COVID-19 in Spain]

Aim of the study

To describe prenatal stress and state anxiety levels in pregnant women living in Spain during the lockdown of the first wave of COVID-19 and its relation with obstetric factors, perception of health care, and concerns about the socio-sanitary situation.

Methods

The present study is an observational, correlational, and cross-sectional quantitative study. The participants in the study were pregnant women recruited through non-probabilistic convenience and snowball sampling during the lockdown. A web link was provided to an online questionnaire designed for this research, which collected socio-demographic and obstetric variables, perceptions of health care received during the pandemic and preoccupations associated with COVID-19. It also included the Prenatal Stress Questionnaire (PDQ) and the State Anxiety Inventory (STAI-S).

Results

Based on the responses of 695 pregnant women, the results showed a mean of 16.98 (SD = 25.20) of prenatal stress and elevated levels of anxiety (M = 25.20/SD = 11.07) in the first wave of the pandemic. Risk factors for prenatal stress and anxiety were the level of preoccupation associated with COVID-19 and previous mental health issues. A specific risk factor for anxiety was having more than one child and a protective factor were perceiving accessibility and availability of health care, with clear and consistent pregnancy care and follow-up protocols.

Conclusions

The lockdown period for COVID-19 was a stressful experience for pregnant women, highlighting the need to address their psychological well-being through clear and coherent protocols in terms of maternal-foetal health control and follow-up.

Anxiety, Stress, and Social Support in Pregnant Women in the Province of Leon during COVID-19 Disease

The COVID-19 pandemic has posed a high risk to the mental health of the entire population. Pregnant women are strongly affected by the consequences of COVID-19, resulting in increased anxiety and stress. Social support can be a protective factor when it comes to mental health disturbances such as anxiety, fear, or stress in pregnant women. This research aims to describe the anxiety and stress of women in the first trimester of pregnancy in times of pandemic and its relationship with social support. A quantitative, descriptive, cross-sectional study was conducted. A total of 115 women in the first trimester of pregnancy participated. Anxiety was found in 78.3% of the women. Self-perceived stress correlated significantly with the dimensions "concern for changes in oneself", "feelings about oneself", "concern about the future", and very weakly with social support. In addition, a negative correlation was observed between "feelings about oneself" and social support. During the COVID-19 pandemic, anxiety levels of women in our population are elevated. Pregnant women during the first trimester of pregnancy showed higher levels of fear of childbirth and concern about the future than multiparous women. Increased social support and decreased stress seem to influence "feeling about oneself".

Knowledge, Fear, and Anxiety Levels Among Pregnant Women During the COVID-19 Pandemic: A Cross-Sectional Study

This study aimed to evaluate pregnant women’s knowledge, fear, and anxiety levels during the coronavirus outbreak. This cross-sectional study was conducted on 170 pregnant women between May 20 and July 10, 2020. Data collection form for demographics and obstetric details, questionnaire on knowledge, attitudes, and practice toward COVID-19, and State-Trait Anxiety Inventory-I were used. The vast majority of pregnant women were afraid of being infected with the COVID-19 and causing mother-to-baby transmission. A positive correlation was found between fear of coronavirus transmission and the level of anxiety (p < .05). Risk perceptions regarding COVID-19 have affected the anxiety and knowledge levels of pregnant women. Based on the findings, knowledge levels, concerns, and fears about the risk of COVID-19 exposure have implications on the anxiety levels of pregnant women. Pregnant women experienced high stress and anxiety levels due to increased risk of COVID-19 transmission during face-to-face antenatal visits.

Young parents' experiences of pregnancy and parenting during the COVID-19 pandemic: a qualitative study in the United Kingdom

Young parents (aged 16–24 years) in the perinatal period are at an increased risk of poor mental health especially during the COVID-19 pandemic, due to multiple risk factors including social and economic instability. COVID-19 related restrictions had profound implications for the delivery of perinatal care services and other support structures for young parents. Investigating young parents’ experiences during the pandemic, including their perceived challenges and needs, is important to inform good practice and provide appropriate support for young parents.

Qualitative interviews were conducted with young parents (n = 21) during the COVID-19 pandemic in the United Kingdom from February – May 2021. Data were analysed using thematic analysis.

Three key themes were identified to describe parents’ experiences during the COVID-19 pandemic. Parents reported specific COVID-19 related anxieties and stressors, including worries around contracting the virus and increased feelings of distress due to uncertainty created by the implications of the pandemic. Parents described feeling alone both at home and during antenatal appointments and highlighted the absence of social support as a major area of concern. Parents also felt their perinatal care had been disrupted by the pandemic and experienced difficulties accessing care online or over the phone.

This study highlights the potential impact of the COVID-19 pandemic on young parents, including their mental wellbeing and the perinatal support they were able to access. Insights from this study can inform the support and services offered to families going forward. Specifically, the findings emphasise the importance of (a) supporting both parents during perinatal appointments, (b) providing parents with mental health support early on and (c) finding ways to facilitate communication pathways between professionals and parents.

Preoperative Anxiety among Adult Patients Undergoing Elective Surgeries at a Tertiary Teaching Hospital: A Cross-Sectional Study during the Era of COVID-19 Vaccination

Anxiety in the perioperative period has significant impact on both the flow of surgery and the post-operative recovery process. The aim of this cross-sectional study is to determine the prevalence of preoperative anxiety among adult patients undergoing elective surgical procedures at a tertiary teaching hospital and the effect of COVID-19 and COVID-19 vaccines on preoperative anxiety. We used the Amsterdam Preoperative Anxiety and Information Scale (APAIS) to assess patients’ anxiety toward surgery and their need for more information. Patients with APAIS about anesthesia and surgery (APAIS-A-T) total score <10 were considered as the low preoperative anxiety group, while patients with APAIS-A-T ≥11 were considered as the high preoperative anxiety group. The overall APAIS-A-T score of the 794 included patients was 8.5 ± 4.5. The mean APAIS-A-T score was 7.0 ± 3.8 among males and 9.6 ± 4.6 among female patients (p < 0.001). The APAIS-A-T score for those who had previously underwent surgery under anesthesia was 8.3 ± 4.4, compared to 9.5 ± 4.8 for those who had not (p = 0.002). No significant difference was found between those with a previous history of COVID-19 and those without (p = 0.105), nor between those who were vaccinated and those who were not (p = 0.550). Sixty-four (26.8%) highly anxious patients were afraid of becoming infected with COVID-19 during their hospital stay (p = 0.009). This fear of COVID-19 in-hospital transmission made 19 (7.9%) highly anxious patients and 36 (4.5%) of the total sample hesitant to undergo this surgery (p = 0.002). In conclusion, this study demonstrated that 30.1% of patients had high preoperative anxiety, with fear of pain after surgery being the most common factor related to anxiety on the day of surgery. Controlling the spread of COVID-19 can play a crucial role in decreasing preoperative anxiety during this pandemic.

Risk factors for depression and anxiety in pregnant women during the COVID-19 pandemic: Evidence from meta-analysis

BACKGROUND

The prevalence of anxiety and depression in pregnant women has significantly increased after the spread of COVID-19 throughout the world. We carried out this meta-analysis to reveal the information about risk factors for depression and anxiety in pregnant women during the COVID-19 pandemic.

METHODS

We searched the PubMed, Embase and CNKI (China National Knowledge Infrastructure) databases for all articles. The odds ratio (OR) corresponding to the 95% confidence interval (95% CI) was used to assess the risk factors for mental health. The statistical heterogeneity among studies was assessed with the Q-test and I2 statistics.

RESULTS

We collected 17 studies including 15,050 pregnant women during the COVID-19 pandemic. Our results found that factors including decrease in the perception of general support and difficulties in household finances have damage effects on anxiety, and factors including undereducated, unemployed during pregnancy, with a chronic physical illness before pregnancy, decrease in the perception of general support, difficulties in household finances, disobey the isolation rules, and smoking during pregnancy have increased risk of depression.

CONCLUSION

Our meta-analysis revealed some risk factors for mental health in pregnant women during COVID-19 pandemic. Mental health interventions in pregnant women may involve targeted methods individually.

Perinatal Anxiety among Women during the COVID-19 Pandemic-A Cross-Sectional Study

INTRODUCTION

The COVID-19 pandemic has changed the way prenatal education and obstetric care are provided. Pandemic-related anxiety, restrictions, limitations in perinatal care, and the inability to be accompanied by a loved one can have negative psychological consequences for future parents and their child. The aim of this study was to analyze the determinants and assess the anxiety of pregnant women in individual trimesters, as well as to learn about the sources of support and medical personnel proceeding methods.

MATERIALS AND METHODS

This research was conducted as a diagnostic survey, using the State-Trait Anxiety Inventory (STAI), Childbirth Anxiety Questionnaire (CAQ), and a standardized interview questionnaire, on 534 pregnant women in Poland. Resultsand Conclusions: The pregnant women, regardless of the trimester of pregnancy, are characterized by: increased anxiety level influenced by the current epidemiological situation, psychophysical condition, previous maternal experiences, participation in classes preparing for childbirth, organization of perinatal care, their relationship with a partner, and the presence of a loved one during childbirth. A negative correlation was shown between the level of childbirth anxiety and maternal experience, as well as the support of a doctor and midwife.

The Relationship between the Fear of Covid-19, Depression, and Spiritual Well-Being in Pregnant Women

The purpose of this study was to explore the relationship between pregnant women's fear of coronavirus (COVID-19), depression, and spiritual well-being. This cross-sectional research was carried out with 336 pregnant women living in a city in the Eastern Anatolia region of Turkey between the 1st of March and 30th of March 2021. For data collection, the scales of the Fear of COVID-19, the Beck Depression Inventory, and the Spiritual Well-being were administered to the participants. The pregnant women's fear of COVID-19 was found to be at a moderate level, their depression was at a mild level, and their spiritual well-being was above the moderate level. It was found that there was a significant negative correlation between the spiritual well-being levels of pregnant women and their fear of COVID-19 and depression. Moreover, it was also found that there was a significant positive correlation between pregnant women's levels of fear of COVID-19 and depression (p < 0.001). It is recommended that relevant spiritual care practices can be disseminated and implemented effectively to reduce pregnant women's fear and depression during the pandemic. In addition, when providing care to pregnant women, health professionals can adopt a holistic approach to increase pregnant women's spiritual well-being.

Prevalence of antenatal depression and associated factors among pregnant women during COVID-19 pandemic in North Shewa zone, Amhara region, Ethiopia

Background

Antenatal depression is a form of depression that occurs during pregnancy. This problem may worsen during the COVID-19 epidemic and may result in serious consequences for pregnant women, including depression and other multiple psychosocial problems. However, the prevalence of depression during the COVID-19 pandemic in pregnant women and its associated factors has not been studied in the study area, even in Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 422 pregnant women who were attending antenatal care in public health institutions in the North Shewa Zone, Ethiopia. The data were collected from May 1- June 30, 2021. A logistic regression model with adjusted odds ratio (AOR) and P-value < 0.05 at the 95% confidence interval was used to determine significantly associated factors.

Results

The prevalence of antenatal depression among pregnant women during the COVID-19 pandemic was 34.1% (95% CI: 29.6-38.9). Divorced marital status (AOR = 7.52, CI: 2.707-20.911), husband's educational status "cannot read and write" (AOR = 4.05, CI: 1.834-8.962) and "can read and write without formal education" (AOR = 2.39, CI: 1.107-5.154) are statistically significant variables associated with depression among pregnant women during the COVID-19 pandemic.

Conclusions

In this study, the prevalence of antenatal depression in pregnant women during the novel coronavirus pandemic was high. To reduce the level of depression in pregnant women, strategies have to be designed for the early detection of divorced pregnant women with inadequate social support and address enough information for pregnant women and their husbands about depression and COVID-19 during the pandemic.

The Impact of Maternal Anxiety on Early Child Development During the COVID-19 Pandemic

Background: Maternal prenatal anxiety is among important public health issues as it may affect child development. However, there are not enough studies to examine the impact of a mother's anxiety on the child's early development, especially up to 1 year. Objective: The present prospective cohort study aimed to examine whether maternal trait anxiety, perceived social support, and COVID-19 related fear impacted speech-language, sensory-motor, and socio-emotional development in 12 months old Serbian infants during the COVID-19 pandemic. Methods: This follow-up study included 142 pregnant women (Time 1) and their children at 12 months (Time 2). Antenatal maternal anxiety and children's development were examined. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI). Child speech-language, sensory-motor, and socio-emotional development were assessed using the developmental scale in the form of an online questionnaire that examined the early psychophysiological child development. Information on socioeconomic factors, child and maternal demographics, clinical factors, and perceived fear of COVID-19 viral infection were collected. Multivariable General Linear Model analysis was conducted, adjusted for demographic, clinical, and coronavirus prenatal experiences, maternal prenatal anxiety levels, perceived social support, speech-language, motor skills, and cognitive and socio-emotional development at the infants' age of 12 months. Results: The study revealed the influence of the COVID-19 pandemic on maternal trait anxiety. The association between selected independent factors and infants' development was found in a demographically unified sample except for employment and the number of children. There was a correlation between all observed developmental functions. Univariate General Linear model statistical analysis indicated that linear models with selected independent factors and covariates could account for 30.9% (Cognition) up to 40.6% (Speech-language) of variability in developmental functions. It turned out that two-way and three-way interactions had a dominant role on models, and STAI-T Level and COVID-19 related fear were present in all interaction terms. Conclusion: Our findings reveal important determinants of child developmental outcomes and underline the impact of maternal anxiety on early child development. These findings lay the groundwork for the following interdisciplinary research on pregnancy and child development to facilitate and achieve positive developmental outcomes and maternal mental health.

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.

[Psychological impact of COVID-19 on women's wellbeing during pregnancy: about 2 cases]

This study is based on a psychoanalytically inspired psychological investigation of two pregnant women with COVID-19 at different stages of pregnancy in the Department of Obstetrics and Gynaecology A at the Charles Nicolle Hospital. Our study was conducted between 2020 and 2021, until deliveries. Two young Tunisian women aged 28 and 30 years were tested positive for COVID-19 during pregnancy. They suffered from emotional shock. In this study, we discuss the different points of collision between life and death by describing, in detail, the experiences of these two women during their confinement.

Pregnancy and Childbirth Expectations During COVID-19 in a Convenience Sample of Women in the United States

The COVID-19 pandemic has transformed the health care landscape and shifted individuals’ expectations for and interactions with essential health services, including pregnancy-related care. This study explores alterations to individuals’ pregnancy and childbirth decisions during an infectious disease pandemic. A convenience sample of 380 pregnant individuals with an expected delivery date between April and December 2020 consented to enroll and complete an online questionnaire on their pregnancy and childbirth expectations during the COVID-19 pandemic; a subset of respondents (n = 18) participated in semi-structured phone interviews. Survey data were analyzed quantitatively while interview data were analyzed using a thematic content analysis until a consensus on key themes was achieved. Respondents reported substantial stressors related to shifting policies of health care facilities and rapidly changing information about COVID-19 disease risks. As a result, respondents considered modifying their prenatal and childbirth plans, including the location of their birth (25%), health care provider (19%), and delivery mode (13%). These findings illuminate the concerns and choices pregnant individuals face during the COVID-19 pandemic and offer recommendations to engage in compassionate, supportive, and person-centered care during a time of unprecedented risk and uncertainty.

An investigation of women's pregnancy experiences during the COVID-19 pandemic: A qualitative study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has adversely affected the physical and psychosocial health of pregnant women and their access to antenatal care and health services.

AIM

To examine women's pregnancy experiences during the COVID-19 pandemic.

MATERIALS AND METHODS

The study was conducted in a qualitative design with 14 pregnant women who were admitted to a state hospital pregnancy outpatient clinic for antenatal control. The data were collected using a semi-structured individual interview form and were analysed using the thematic analysis technique. COREQ checklist guide was followed in the study.

RESULTS

The pregnancy experiences of women in the COVID-19 pandemic were examined under 7 main themes: "physical health, psychosocial health, adaptation to pregnancy, pregnancy follow-ups, social life, spouse relationship and coping methods". Pregnant women have both positive and negative pregnancy experiences in the COVID-19 pandemic.

CONCLUSION

The study concluded that the pandemic has affected both the physical and psychosocial health of pregnant women, their social life, marital relationship and access to antenatal care services. Health professionals need to evaluate psychosocial health as well as the physical health of pregnant women, especially during the pandemic, and create a care plan accordingly. Midwives and other health professionals should improve the bio-psychosocial health of the pregnant/family via telehealth and counselling services.

Psychological Distress Among Ethiopian Pregnant Women During COVID-19: Negative Correlation with Self-Efficacy

BACKGROUND

Since the onset of coronavirus disease 2019, the mental health of individuals has been negatively affected, especially among vulnerable groups.

OBJECTIVE

The aim of this study was to explore the association of psychological distress with self-efficacy and other correlates among Ethiopian pregnant women.

METHODS

A cross-sectional study was carried out among 384 pregnant women from August 1 to 15, 2020. Pandemic-related psychological distress was measured by the Impact of Event Scale Revised (IES-R). Hospital anxiety and depression scale (HADS), generalized self-efficacy scale (GSES), and fear of COVID-19 scale (FCoV-19S) were employed to examine independent variables. A consecutive sampling technique was employed and the data were analyzed by SPSS version 23.0. Categorical variables were presented in terms of frequencies and percentages; and mean with SD was employed to express continuous variables. Multiple regressions were performed; and for statistical significance, p < 0.05 and 95% CI were considered.

RESULTS

The participants had 31.3 (SD±7.7) mean age and those participants between the ages of 25-34 were dominant. The mean score of IES-R scale was 45.1 (±17.4) indicating severe psychological distress. The IES-R mean score for primiparous women was significantly higher than the mean score of multiparous women. Psychological distress has a strong positive correlation with symptoms of anxiety, depression and fear of COVID-19. In contrast, a negative relationship was found between psychological distress and participants' self-efficacy.

CONCLUSION

The results indicate that the current pandemic has imposed severe psychological distress among pregnant women. The presence of anxiety, depressive symptoms, and pandemic-related fears were identified as positive predictors. In contrast, better self-efficacy of the pregnant women was linked to lower psychological distress. For health-care professionals, broadening the focus and collaboration among service-delivering units are important in halting undesirable outcomes of the pandemic.

The Psychological Impact of COVID-19 Pandemic on Women's Mental Health during Pregnancy: A Rapid Evidence Review

BACKGROUND

The perinatal period is a particularly vulnerable period in women's lives that implies significant physiological and psychological changes that can place women at higher risk for depression and anxiety symptoms. In addition, the ongoing pandemic of coronavirus disease 2019 (COVID-19) is likely to increase this vulnerability and the prevalence of mental health problems. This review aimed to investigate the existing literature on the psychological impact of the COVID-19 pandemic on women during pregnancy and the first year postpartum.

METHOD

The literature search was conducted using the following databases: Pubmed, Scopus, WOS-web of science, PsycInfo and Google Scholar. Out of the total of 116 initially selected papers, 17 have been included in the final work, according to the inclusion criteria.

RESULTS

The reviewed contributions report a moderate to severe impact of the COVID-19 outbreak on the mental health of pregnant women, mainly in the form of a significant increase in depression-up to 58% in Spain-and anxiety symptoms-up to 72% in Canada. In addition to the common psychological symptoms, COVID-19-specific worries emerged with respect to its potential effects on pregnancy and the well-being of the unborn child. Social support and being engaged in regular physical activities appear to be protective factors able to buffer against the effects of the pandemic on maternal mental health.

CONCLUSIONS

Despite the limitations of the study design, the evidence suggests that it is essential to provide appropriate psychological support to pregnant women during the emergency in order to protect their mental health and to minimize the risks of long-term effects on child development.

Use of Mobile Applications by Pregnant Women and Levels of Pregnancy Distress During the COVID-19 (Coronavirus) Pandemic

OBJECTIVE

Pregnancy and postpartum periods require continuity in care and counseling. During the pandemic process, telemedicine and telenursing applications have been used to meet the need for healthcare throughout the world, and skills in this area have been developed. This study aimed to identify the use of mobile applications by pregnant women in receiving health information, counseling, and healthcare during the COVID-19 pandemic and their distress levels during pregnancy.

METHODS

This research was a descriptive cross-sectional study. The study was designed as an online survey administered between August 2020 and November 2020 via a questionnaire and the Tilburg Pregnancy Distress Scale (TPDS). A total of 376 women agreed to participate in the study. Women were included if they were literate, had a gestational age of ≥ 12th weeks, and accommodated within the Republic of Turkey's boundaries.

RESULTS

A total of 77.9% of participants reported using pregnancy-related mobile applications during the pandemic. The mean total Tilburg Pregnancy Distress Scale score was 24.09, and 37.2% of the participants were found to be at risk for high distress according to the cut-off point. There was a significant difference between the change in receiving health services and the anxiety about coronavirus transmission and the Tilburg Pregnancy Distress Scale total score. (p ≤ 0.05).

CONCLUSIONS

This study helped understand the pandemic's impact on pregnancy distress and usage of mobile health applications by pregnant women during the pandemic. Also, our results indicate that a decrease in pregnant women receiving health services during this period. Mobile health applications appear to be usable for prenatal follow-ups because mobile applications are common among pregnant women during the COVID-19 pandemic.