Pregnancy-related anxiety and its associated factors during COVID-19 pandemic in Iranian pregnant women: a web-based cross-sectional study

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.

Anxiety, prenatal distress, and resilience during the first trimester of gestation

OBJECTIVE

To describe and analyze the relationship between pregnancy-related anxiety, prenatal distress, and individual resilience in pregnant women during the first trimester of pregnancy and compare it with the obstetric variable of parity.

METHOD

Quantitative, descriptive, cross-sectional study using non-probabilistic circumstantial sampling. A total of 144 women participated. The Prenatal Distress Questionnaire, the Resilience Scale, and the Pregnancy-Related Anxiety Questionnaire were used. A descriptive analysis with measures of central tendency was performed, and the reliability of the instruments was assessed.

RESULTS

The average age was 33.57 years. 58.3% were multiparous and 41.7% primiparous. Anxiety was found in 21.5% and very high levels of resilience in 54.9%. Primiparous women showed higher levels of worry about the future and fear of childbirth than multiparous women. Pregnant women with high resilience showed lower levels of anxiety and stress.

CONCLUSION

Pregnant women with higher levels of resilience show less anxiety and stress during the first trimester of pregnancy. Primiparous women show more anxiety and stress than multiparous women.

Effectiveness of preoperative multimedia educational sessions on the levels of anxiety and satisfaction among women undergoing cesarean: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to explore the effectiveness of preoperative multimedia educational sessions on the levels of anxiety and satisfaction among women undergoing cesarean section (CS). The Scopus, PubMed, and Cochrane databases were searched without language limitations for eligible randomized controlled trials (RCTs) published from their inception up to October 15, 2023. A random-effect meta-analysis was conducted, and the quality of this meta-analysis was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Seven RCTs (n = 1006 women) met the inclusion criteria. Preoperative multimedia sessions were found to significantly reduce anxiety levels (n = 6 RCTs, weighted mean difference: -3.10; 95 percent confidence intervals (CI): -4.48, -1.73; I2 = 44.24 percent, moderate certainty of evidence) compared to the control group. However, there was no significant difference between the two groups regarding women's satisfaction after surgery (n = 5 RCTs, risk ratio: 1.37; 95 percent CI: 0.76, 2.50; I2 = 98.26 percent, moderate certainty of evidence). Leave-one-out sensitivity analysis showed robustness of the outcomes. The findings of this meta-analysis suggest that providing multimedia educational programs before surgery could potentially have a beneficial effect on the levels of anxiety experienced by women undergoing CS. However, it is imperative to validate these results through larger samples and multi-centered RCTs.

Contactless exercise intervention in prenatal and postnatal period during COVID-19 lowers the risk of postpartum depression

The COVID-19 pandemic has had a substantial adverse impact on the physical and mental health of pregnant and postpartum women, thereby increasing the risk of postpartum depression (PPD). This study aimed to evaluate the effectiveness of a continuous contactless exercise intervention in reducing the risk of depression during the prenatal and postnatal periods. The study utilized an interactive contactless exercise program consisting of Pilates movement over a 16-week period, with 8 weeks during pregnancy and 8 weeks after childbirth. Metabolic and psychological factors related to postpartum depression, including pain, stress, and stress-response markers, were analyzed. The results showed that the exercise intervention significantly alleviated postpartum depression by improving pain (Oswestry Disability Index: Non-exercise, 11.4 ± 14.8 versus Exercise, - 63.1 ± 18.4, p < .001) and stress factors (Edinburgh Postnatal Depression Scale: Non-exercise, 8.8 ± 8.72 versus Exercise, - 37.6 ± 9.13, p < .001; Perceived Stress Scale: Non-exercise, 9.21 ± 9.35 versus Exercise, - 20.7 ± 14.4, p < .001) caused by physical/structural imbalances in postpartum women. Additionally, the intervention improved the metabolic imbalances commonly observed after childbirth, including reductions in triglyceride (Interaction effect, p = .017), insulin (Interaction effect, p = .032), and cortisol levels (Interaction effect, p < .001), which are recognized risk factors for postpartum depression. Taken together, these findings suggest that contactless online exercise interventions can mitigate postpartum depression by addressing metabolic dysregulation that frequently occurs after delivery, especially in situations of social isolation caused by the pandemic.

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.

Exploring the Midwives' Experiences of Providing Delivery Care for Women with Suspected or Confirmed COVID-19 Infection: A Qualitative Study

Introduction

Midwives were at the forefront of caring for pregnant women during the COVID-19 pandemic, therefore, the present study was conducted with the purpose of exploring midwives' experiences of providing delivery care for women with suspected or confirmed COVID-19 infection.

Methods

In this qualitative study, 18 midwives working in the public hospitals affiliated with Guilan University of Medical Sciences (Iran). Who had experience in providing delivery care to women with suspected or confirmed COVID-19 infection were selected using purposive sampling. Data were collected via individual semi-structured interviews until reaching data saturation, and analyzed through conventional content analysis.

Results

Data analysis led to the extraction of three main categories and six sub-categories. The main categories included "COVID-19 and organizational support" with two sub-categories including lack of resources/neglecting the role of midwives, "COVID-19 and positive achievements" with two sub-categories including professional resilience/turning threats into opportunities, "COVID-19 and informational support" with two sub-categories, including up-to-date training/empowering pregnant women.

Conclusion

According to the findings, to realize and guarantee the provision of high-quality maternity care to pregnant women in dealing with epidemic diseases such as COVID-19 in the future, the attention of policymakers and healthcare service officials to the physical and psychological needs of midwives is necessary. Also, organizational and informational support, improving job satisfaction, and paying attention to the importance of midwives' role in the medical team are recommended. Moreover, empowering pregnant women during epidemic diseases is essential.

Effect of psychological care on the prenatal mental state and vaginal delivery in pregnant women during the early stages of the COVID-19 epidemic

The COVID-19 pandemic has had a profound impact on the lives of people globally, including pregnant women. We aimed to explore the influence of a psychological care intervention based on behavioral change theory on the prenatal mental state and mode of delivery in pregnant women from June 2020 to June 2022 during the early stage of the COVID-19 epidemic in China. A retrospective analysis was conducted of the records of pregnant women who delivered in our hospital from June 2020 to June 2022. They were assigned to an observation and a control group according to the care that they received. The Symptom Checklist-90 (SCL-90) was used to evaluate their negative emotions. The duration of each labor stage and the mode of delivery (cesarean section, spontaneous vaginal delivery, or assisted vaginal delivery) were recorded. A total of 216 women were included in the analysis. Before care, there were no significant differences in the SCL-90 scores between the 2 groups. After delivery, the SCL-90 scores in the observation group were significantly lower than those in the control group. The vaginal delivery rate in the observation group was 92.59%, which was significantly higher than that in the control group (70.39%). The duration of the first stage of labor and the total duration of labor in the observation group were 447.95 ± 53.45 minutes and 498.15 ± 35.14 minutes, respectively, which were significantly lower than those in the control group. The implementation of psychological care based on behavioral change theory in pregnant women during the early stage of the COVID-19 epidemic significantly improved their prenatal psychological state, promoted vaginal delivery, and help shorten the labor process, and reduce the risk of adverse pregnancy outcomes. This intervention is thus worth promoting.

Social support, health literacy and anxiety among pregnant women during coronavirus 2019 pandemic in Thailand

Background

The ongoing coronavirus disease 2019 (COVID-19) pandemic continues to have a significant impact. Pregnant women are particularly vulnerable to its effects, which may increase their anxiety levels. This study aims to investigate anxiety levels in pregnant women during the COVID-19 pandemic in Thailand and to identify factors predicting such anxiety.

Methods

The researchers collected data through an online questionnaire from November 2021 to May 2022. The sample included 404 pregnant women. The questionnaire consisted of personal information, health literacy related to COVID-19, social support, and anxiety related to COVID-19. The content validity of the questionnaire were verified by three experts, with content validity indices of 0.87, 0.80, and 0.87 for each domain, respectively. The reliability of the questionnaire were 0.96 for health literacy, 0.95 for social support, and 0.96 for anxiety. Moreover, in-depth telephone interviews were also conducted with pregnant women. The data were analyzed using descriptive statistics, stepwise multiple regression, and content analysis.

Results

Group of 404 pregnant women were studied, and the results showed that pregnant women had a high level of health literacy regarding COVID-19 and pregnancy (mean = 96.36, SD = 14.23) and social support level on a high level (mean = 83.99, SD = 11.34). Most of them were concerned about anxiety related to COVID-19 infection and pregnancy on a moderate level (mean = 47.78, SD = 11.49). The factors predicting the anxiety of pregnant women during the COVID-19 outbreak in Thailand included health literacy related to COVID-19 (β = 0.468) and social support (β = 0.283), with a prediction rate of 32.80% (R2 = 0.328) with statistical significance (p < 0.05).

Conclusion

This study revealed the anxiety level of pregnant women during the COVID-19 outbreak in Thailand, which was moderate. Health literacy about COVID-19 and social support can predict the anxiety level of pregnant women.

Mental health status of pregnant women during COVID-19 in healthcare centers of Iran: A cross-sectional study

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic impacted every single aspect of life. In addition to being a public health emergency, the COVID-19 outbreak impacted the mental health of individuals, especially pregnant women. This study aimed to examine the mental health status of pregnant women and also the effect of sociodemographic factors on their mental health status during COVID-19 in healthcare centers of Iran.

METHODS

This cross-sectional, analytical-descriptive study was conducted among pregnant women referring to healthcare centers in Shoushtar, Iran, in 2021. Multistage cluster sampling was used to select participants. Data were collected using the General Health Questionnaire-28 (GHQ-28). Data were analyzed using SPSS software version 22. The Pearson correlation coefficient was used to examine the association between quantitative variables. A generalized linear model (GLM) was applied to estimate the effect of independent variables on the dependent variable (mental health).

RESULTS

A total of 197 participants with a mean ± SD age of 27.85 ± 6.37 years took part in this study. The total mean score of mental health was estimated at 17.47±8.20. The highest mean ± SD score was, respectively, related to social dysfunction (6.63 ± 2.86), anxiety and insomnia (5.28 ± 3.53), and somatic symptoms (4.17 ± 3.27). Mental health disorder was significantly correlated with participants' age (R = .223, P = .00), number of pregnancy (gravida) (R = .272, P = .00), number of births (para) (R = 0.272, P = .00), and number of abortions (R = .172, P = .015). About 80% of pregnant women did not reveal impaired mental health conditions or psychological distress, while 19.3% showed scores that indicate probable mental health conditions.

CONCLUSION

Social dysfunction was the most common mental health problem among pregnant women. It is necessary to pay more attention to the mental health status of pregnant women during a pandemic. Interventions such as practical strategies to promote social support and improve pregnant women's mental health during pregnancy are highly important.

Anxiety and depression among perinatal women during the long-term normal prevention of COVID-19 pandemic period in China: a cross-sectional study

BACKGROUND

COVID-19 has increased the probability of occurrence of maternal anxiety and depression in pregnant women. However, there is limited research on anxiety and depression among pregnant women during the long-term normal prevention of COVID-19 pandemic period. This study aimed to examine the anxiety and depression and influencing factors among perinatal women during the long-term normal prevention of COVID-19 pandemic period in China.

METHODS

A cross-sectional survey was designed. A total of 1338 pregnant women were studied. The prenatal anxiety and depression were assessed by the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS), respectively. Postnatal depression was assessed by the Edinburgh Postpartum Depression Scale (EPDS) in 10-14 days after delivery. The data analysis was processed by SPSS9.0. Descriptive analysis was expressed by mean and standard deviation. The counting data were expressed by percentage, χ2 test, multiple linear regression and binary logistic regression.

RESULTS

The incidence of prenatal anxiety (SAS score ≥ 50) was 27.95% (374 cases), prenatal depression (SDS score ≥ 0.5) was 34.01% (455 cases), and postpartum depression (EPDS score ≥ 0.5) was 25.04% (335 cases). Both the prenatal SAS score (r = 0.635, P < 0.001) and prenatal SDS score (r = 0.738, P < 0.001) were related to postpartum depression. Pregnant women who were younger than 35 years, in middle household income, lower education level, underweight before pregnancy, primiparous, and fear of being infected were at increased risk for developing anxiety and depression during the long-term normal prevention of COVID-19 pandemic.

CONCLUSIONS

The incidences of postpartum depression among perinatal women during the long-term normal prevention of COVID-19 pandemic period were a little lower than those during the COVID-19 outbreak period, but still higher than those before the COVID-19.

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.

Global knowledge, attitude, and practice towards COVID-19 among pregnant women: a systematic review and meta-analysis

BACKGROUND

Pregnant women form a specially vulnerable group due to unique changes in pregnancy, leading to a higher risk of getting a severe infection. As severe COVID-19 increases the risk of preeclampsia, preterm delivery, gestational diabetes, and low birth weight in pregnancy, there is a need to enhance pregnant women's knowledge, attitudes, and practices to prevent these complications. This systematic review and meta-analysis aimed to determine their levels of knowledge, attitudes, and practice (KAP) regarding COVID-19 at the global level.

METHODS

The systematic literature search was conducted in the English language, including Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, EMBASE, Springer, and ProQuest, from the occurrence of the pandemic until September 2022. We used The Newcastle Ottawa scale for cross-sectional studies checklist to evaluate the risk of bias in the studies. Data were extracted by a Microsoft Excel spreadsheet and analyzed by STATA software version 14. We also employed Cochran Q statistics to assess the heterogeneity of studies and utilized Inverse variance random-effects models to estimate the pooled level of pregnant women's KAP towards COVID-19 infection prevention.

RESULTS

Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and inclusion criteria, 53 qualified studies were acquired from several countries. In total, 51 articles (17,319 participants) for knowledge, 15 articles (6,509 participants) for attitudes, and 24 articles (11,032 participants) for practice were included in this meta-analysis. The pooled good knowledge, positive attitude, and appropriate practice in pregnant women were estimated at 59%(95%CI: 52-66%), 57%(95%CI: 42-72%), and 53%(95%CI: 41-65%), respectively. According to subgroup analysis, the level of knowledge, attitude, and practice were 61%(95%CI: 49-72), 52%(95%CI: 30-74), and 50%(95%CI: 39-60), respectively, in Africa, and 58.8%(95%CI: 49.2-68.4), 60%(95%CI: 41-80) and 60% (95%CI: 41-78), respectively, in Asia.

CONCLUSION

The Knowledge, attitude, and practice towards COVID-19 infection prevention in pregnant women were low. It is suggested that health education programs and empowerment of communities, especially pregnant women, about COVID-19 continue with better planning. For future studies, we propose to investigate the KAP of COVID-19 in pregnant women in countries of other continents and geographical regions.

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.

COVID-19 vaccine reluctance and possible driving factors: A comparative assessment among pregnant and non-pregnant women

The coronavirus disease of 2019 (COVID-19) constitutes a serious threat to pregnant women. One of the key strategies for preventing and managing the COVID-19 epidemic is vaccination. Herd immunity is significantly hampered by COVID-19 vaccine reluctance, which poses a potential threat to population health. Therefore, the present work intends to ascertain the incidence and severity of COVID-19 vaccine hesitancy among Pakistani pregnant women, the determinants driving their decision, and a comparative assessment with non-pregnant participants. This cross-sectional survey was carried out from November 2021 to February 2022. The validated vaccination attitude examination (VAX) scale about vaccination reluctance was undertaken by participants, who were also required to indicate whether they would be inclined to acquire the COVID-19 vaccine along with the reasons for reluctance. In comparison to the non-pregnant category with 353 participants, the group of 372 pregnant participants who responded to the questionnaire had a much greater proportion of hesitant respondents. Likewise, contrasted to 31% of non-pregnant participants, about 40% of them attributed their willingness to get vaccinated against coronavirus to social media. They also demonstrated a considerably stronger mean score on all subcategories of the VAX measure. The adjusted odd ratio findings showed that the independent factors for vaccine reluctance appeared to be trusting rumors on social media (adj OR: 2.58), not being afraid of covid-19 (adj OR: 2.01), not believing in COVID-19 existence (adj OR: 2.53), and not believing in vaccines (adj OR: 4.25). Uncertainty about the COVID-19 vaccine is very prevalent among expectant mothers. The investigation accentuates the pressing need to administer COVID-19 vaccination to the general public, including expectant mothers who might be anxious about the vaccine.

Self perceived health and stress in the pregnancy during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has had numerous maternal and neonatal consequences, especially at the mental level. Pregnant women experience a rise in anxiety symptoms and prenatal stress.

Aims

The aim was to describe self-perceived health status, general stress and prenatal stress and to analyze relations and associations with sociodemographic factors.

Methods

A quantitative, descriptive and cross-sectional study was conducted using non-probabilistic circumstantial sampling. The sample was recruited during the first trimester of pregnancy during the control obstetrical visit. The Google Forms platform was used. A total of 297 women participated in the study. The Prenatal Distress Questionnaire (PDQ), the Perceived Stress Score (PSS) and the General Health Questionnaire (GHQ-28) were used.

Results

Primiparas presented higher levels of worry about childbirth and the baby (10.93 ± 4.73) than multiparous women (9.88 ± 3.96). Somatic symptoms were present in 6% of the women. Anxiety-insomnia was scored positively by 18% of the women. In the Spearman correlation analysis, statistically significant values were found between almost all study variables. A positive correlation was observed between self-perceived health and prenatal and general stress levels.

Discussion

During the first trimester of gestation, prenatal concerns increase when levels of anxiety, insomnia and depression also increase. There is a clear relationship between prenatal worries, anxiety, insomnia and depression with stress. Health education that focuses on mental health of pregnant women would help reduce worries during pregnancy and would improve the pregnant women perception of her health and well-being.

Experiences of A Population of Recovered Iranian Pregnant Women from COVID-19: A Qualitative Study

BACKGROUND

It seems pandemics may have a notable potential adverse effect on the pregnant women. The important biological COVID-19 aspect of the pregnancy has been led to the neglect of its psychological aspect of the pregnant women, especially COVID-19 affected. The present qualitative study aims to explore the experiences of Iranian pregnant women who were recovered from the COVID-19 pandemics.

MATERIALS AND METHODS

This qualitative study designed based on a semi-structured interview with 9 pregnant women who had developed COVID-19 during pregnancy and had recovered.

RESULTS

Data analysis revealed five themes including: anxiety and helplessness, stigma, confront disease, apprehension in the heart of desire, and seeking calmness. Rrecovered pregnant women from COVID-19 spoke of their mixed feelings; being happy with their survival and that of their fetus, despite getting the disease, along with anxiety and fear of the future, which had resulted in the continuation of pregnancy in the limbo of ambiguity and expectation. Recovered pregnant women during unknown pandemics, despite being saved from disease, continue to tolerate concerns about their unborn child.

CONCLUSION

Recovered pregnant women during unknown pandemics, despite being saved from disease, continue to tolerate concerns about their fetus. Therefore, they require comprehensive and complete management approaches that require familiarity with the psychological challenges of this group of patients.

A propensity score matching study: The prevalence of mental health problems among pregnant women at first antenatal care increased in Chongqing during the first wave of the COVID-19 pandemic

Background

The 2019 coronavirus disease (COVID-19) pandemic increased the risks of mental health challenges, especially anxiety and depression. However, the impact of COVID-19 on mental health during pregnancy has not been fully established. Therefore, we investigated the impact of the COVID-19 pandemic on maternal mental health.

Methods

Two cohorts of pregnant women at their first antenatal care in the First Affiliated Hospital of Chongqing Medical University were enrolled in this study. One cohort was enrolled before the COVID-19 outbreak, from 1 June to 31 December 2019 (n = 5,728, pre-COVID-19 group), while the other was enrolled during the COVID-19 pandemic, from 24 January to 23 March 2020 (n = 739, COVID-19 pandemic group). Symptoms of depression, anxiety, and somatization disorders were assessed by the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-15 (PHQ-15), with a cutoff point of 10 for moderate-to-severe depression, anxiety, and somatoform symptoms. The propensity score matching method (1:1) was used to balance differences in demographic characteristics between groups. A chi-square analysis was performed to compare differences in demographic characteristics between the groups.

Results

Prevalence of moderate-to-severe depression, anxiety, and somatoform symptoms among pregnant women at their first antenatal care visit during the COVID-19 pandemic (9.5, 2.2, and 20.8%, respectively) was significantly lower than those before the pandemic (16.3, 4.4, and 25.7%, respectively) (p < 0.05). Compared with the same period before the pandemic, during the pandemic, the number of women newly registered for antenatal care decreased by nearly 50%. There were significant differences in the distributions of demographic characteristics between the groups (p < 0.05). After matching the demographic characteristics, differences in the prevalence of maternal mental health disorders between the groups reversed dramatically. Prevalence of moderate-to-severe depression, anxiety, and somatoform symptoms during the COVID-19 pandemic in this population (2.3, 9.6, and 20.8%, respectively) was significantly higher than those before the pandemic (0.3, 3.9, and 10%, respectively) (p < 0.05).

Conclusion

The COVID-19 pandemic increased mental health risks among pregnant women. As a large proportion of pregnant women with mental health challenges delay their prenatal care or change healthcare facilities after the outbreak of public health emergencies, there is a need to establish a balanced healthcare system in medical institutions at all levels.

The relationship among pregnancy-related anxiety, perceived social support, family function and resilience in Chinese pregnant women: a structural equation modeling analysis

BACKGROUND

Accumulating evidence suggests that pregnancy-related anxiety (PRA) has adverse impacts on maternity health and infant development. A substantial body of literature has documented the important influence of family function, perceived social support and resilience on PRA. However, research identifying the mediating mechanisms underlying this relationship in China are still lacking. Therefore, the current study aimed to investigate the prevalence of PRA under the three-child policy in China, and also explore the interrelationships among perceived social support, family function, resilience, and PRA.

METHODS

In this cross-sectional study, a convenient sampling method was used to select 579 pregnant women who underwent prenatal examination at the maternity outpatient departments of the First Affiliated Hospital of Chongqing Medical University in China from December 2021 to April 2022. Participants were required to complete the following questionnaires: the demographic form, the Chinese Pregnancy-related Anxiety scale, the 10-item Connor-Davidson Resilience Scale, the APGAR Family Care Index Scale, and Multidimensional Scale of Perceived Social Support. Pearson correlation analysis was utilized to examine the rudimentary relationship among the study variables. Bootstrapping analyses in the structural equation modeling were applied to identify the significance of indirect effects.

RESULTS

There were 41.4% of pregnant Chinese women indicating PRA. Correlational analyses indicated that perceived social support, family function and resilience were negatively associated with PRA (r = - 0.47, P < 0.01; r = - 0.43, P < 0.01; r = - 0.37, P < 0.01, respectively). The results of bootstrapping analyses demonstrated significant indirect effects of perceived social support (β = - 0.098, 95% CI [- 0.184, - 0.021]) and family function (β = - 0.049, 95% CI [- 0.103, - 0.011]) on PRA via resilience.

CONCLUSIONS

Chinese pregnant women are suffering from high levels of PRA. Better family function and perceived social support might reduce the occurrence of PRA, as well as by the mediating effects of resilience. Healthcare providers must be concerned about PRA and perform corresponding actions to reduce it. By strengthening social support and improving family function, antenatal care providers could effectively reduce or prevent PRA. And more importantly, implementing resilience-promoting measures are also essential to relieve anxiety and support mental health in pregnant women.

Maternal Anxiety and Its Associated Factors During the First and Second Wave of COVID-19 Pandemic in Serbia: A Cross-Sectional Study

Aim

The COVID 19-pandemic affects people differently, while pregnant women are among the most sensitive populations. The data about maternal mental health during the COVID-19 outbreak are in some ways consistent but also country-specific.

Purpose

The study aims to explore the impact of the COVID-19 pandemic on pregnant women's anxiety and identify its associated factors.

Patients and Methods

This cross-sectional study included a sample of 358 pregnant women during the first and second waves of the pandemic in Serbia. An anonymous survey included basic demographic questions, pregnancy-related background questions, the question of self-reported COVID-19-related fear, State-Trait Anxiety Inventory (STAI), and Multidimensional Scale of Perceived Social Support (MSPSS).

Results

The study revealed no pregnant women with low anxiety levels measured by STAI-T and STAI-S, while the STAI-S and STAI-T scores indicated high anxiety in 32.4% and 42.7% of pregnant women, respectively. The obtained results pointed out the nonlinear dependence of state anxiety on observed associated factors and their complex interactions, including the data collecting period.

Conclusion

Our findings reveal that COVID-19 affects pregnant women's mental health and makes it necessary for psychological monitoring and support for pregnant women, which may be reflected in their mental health but also the development of their offspring.

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

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

The COVID-19 pandemic and mental health in pregnant women: A review article

A rapid spreading of the COVID-19 virus in recent years had a great impact on every single aspect of live and the world faced with unexpected and unpredictable crisis in both physical and mental condition. As with any crisis, vulnerable individuals like pregnant women were the concern of societies. Several physiological and psychological changes occur during pregnancy which put individuals in a risk of mental health problems. During the outbreak of the COVID-19, pregnant women have experienced more psychological stresses, fear, anxiety, and depression. The prenatal mental distresses and psychiatric disorders may cause poor compliance, reduce help-seeking behaviors, and neglect to take the follow up screening visits and risk of harm for mother and others. Addressing the mental health in pregnant women is crucial to prevent the consequences. The purpose of this narrative review was to investigate the available literature on the impact of the COVID-19 pandemic on mental health in pregnant women and provide some recommendations to improve mental health in them. It also shed some light on providing mental health services for women during pregnancy and can be used by health professionals and policymakers.

Interoceptive anxiety-related processes: Importance for understanding COVID-19 and future pandemic mental health and addictive behaviors and their comorbidity

The COVID-19 pandemic is associated with an increased prevalence of mental health problems and addictive behaviors. There is a growing theoretical and empirical evidence that individual differences in interoceptive anxiety-related processes are a one set of vulnerability factors that are important in understanding the impact of pandemic-related mental health problems and addictive behavior. However, there has not been a comprehensive effort to explore this rapidly growing body of research and its implications for public health. In this paper, we discuss why interoceptive anxiety-related processes are relevant to understanding mental health and addictive behaviors during the COVID-19 pandemic. We then provide a narrative review of the available COVID-19 literature linking interoceptive fear and anxiety-related processes (e.g., anxiety sensitivity, health anxiety, and COVID-19 anxiety, fear, and worry) to mental health and addictive behaviors. We then propose a novel transdiagnostic theoretical model that highlights the role of interoceptive anxiety-related processes in mental health and addictive behavior in the context of the present and future pandemics. In the final section, we utilize this conceptualization to underscore clinical implications and provide guidance for future research initiatives in the management of COVID-19 mental health and addictive behaviors and inform the public health field for future pandemics.

Hesitancy about COVID-19 vaccination among pregnant women: a cross-sectional study based on the health belief model

BACKGROUND

Pregnant women are at high risk for affliction by coronavirus disease 2019 (COVID-19). Vaccination is a main strategy to prevent and manage the COVID-19 pandemic. However, hesitancy about COVID-19 vaccination (HACV) is a major public health threat and a major barrier to herd immunity. The aim of the study was to evaluate pregnant women's HACV based on the Health Belief Model (HBM).

METHODS

This cross-sectional study was conducted in 2021-2022. Participants were 352 pregnant women selected from several healthcare centers in the north of Iran. Instruments for data collection were a demographic questionnaire, a COVID-19 Knowledge Questionnaire, a COVID-19 Health Belief Questionnaire, and a question about HACV. Logistic regression analysis was used to assess the effects of the study variables on HACV.

RESULTS

The rate of HACV was 42.61%. In the regression model, the three factors of perceived benefits (aOR: 0.700; 95% CI: 0.594 to 0.825), cues to action (aOR: 0.621; 95% CI: 0.516 to 0.574), and history of reproductive problems (aOR: 2.327; 95% CI: 0.1.262 to 4.292) had significant effects on HACV (P <  0.001).

CONCLUSION

HACV is highly prevalent among pregnant women. The perceived benefits and cues to action components of HBM have significant effects on pregnant women's HACV, while the perceived threat component has no significant effect on it. HBM is a good model to explain HACV among pregnant women. Educational interventions are necessary to improve pregnant women's awareness of the risks of COVID-19 for them and their fetus.

Generalized Anxiety Disorder and Its Associated Factors Among Pregnant Women During COVID-19 at Public Health Facilities of East Gojjam Zone, 2020: A Multi-Center Cross-Sectional Study

Introduction

Pregnant women suffer from varying levels of generalized anxiety disorder that result in poor obstetrical outcomes. Therefore, this study aimed to assess the prevalence and factors associated with generalized anxiety disorder among pregnant women attending antenatal care during COVID-19 at the public health facilities in the east Gojjam zone.

Methods

A health facility-based cross-sectional study was conducted, from 1–30 December 2020. A total of 847 pregnant women were included in the study using a systematic random sampling technique. We used an interviewer-administered questionnaire to collect the data. Bivariate and multivariable logistic regression was used to identify factors associated with the outcome variable. Statistical significance was determined using a p-value < 0.05 and a 95% confidence level.

Results

The prevalence of generalized anxiety disorder was 43.7%, with a 95% CI (40.28–47.12). Having <3 the number of children (AOR: 1.53; 95% CI: 1.11–2.13, having a negative attitude about COVID (AOR: 1.47; 95% CI: 1.07–2.02 and having a high-risk perception about COVID (AOR: 1.86; 95% CI: 1.34–2.57 were factors significantly associated with generalized anxiety disorder.

Conclusions

The study found that the prevalence of generalized anxiety disorder was high. Having less than three children, having a negative attitude, and having a high-risk perception of COVID were independent risk factors of generalized anxiety disorder. Appropriate interventions should be considered to address generalized anxiety disorder during the pandemic.

Anxiety among Pregnant Women Attending Obstetrics Unit of a Tertiary Care Centre during the COVID-19 Pandemic: A Descriptive Cross-sectional Study

Introduction

The disastrous effect of COVID-19 pandemic on the mental health of vulnerable populations like pregnant women should not be neglected. The objective of the study was to find out the prevalence of anxiety among pregnant women attending the obstetrics unit of a tertiary care centre during the COVID-19 pandemic.

Methods

A descriptive cross-sectional study was conducted from 16 May 2020 to 30 July 2020 among pregnant women attending obstetrics unit of a tertiary care centre. Ethical approval was obtained from the Institutional Review Committee (Reference number: 365/076/077-IRC). Convenience sampling method was used. Pregnancy-related anxiety questionnaires were used and semi-structured questionnaires were used for sociodemographic data. Point estimate and 95% Confidence Interval were calculated.

Results

Out of 115 pregnant women, anxiety was found in 21 (18.26%) (11.20-25.32, 95% Confidence Interval).

Conclusions

Anxiety among the pregnant women reported in this study was found to be lower than similar studies conducted in similar settings.

Keywords

anxiety; COVID-19; pregnancy.

Predictor role of COVID-19 anxiety on maternal competency with mediating role of mother-infant attachment: A study of structural equation modeling

Introduction

COVID-19 pandemic is one of the factors that can increase anxiety and stress levels in pregnant women. Anxiety reduces the maternal-infant attachment. Mother-infant attachment can play an important role in maternal competency. The aim of this study was to predict effect of COVID-19 anxiety during pregnancy and the postpartum period on the maternal competency with mediating role of maternal-infant attachment.

Method

A prospective longitudinal study was conducted on 253 pregnant women in the third trimester of pregnancy that referred to the health centers of Iran University of Medical Sciences and met the study inclusion criteria. Demographic questionnaire and the COVID-19 anxiety scale completed during the third trimester of pregnancy and after the delivery and Müller's mother-infant attachment and maternal competency questionnaire completed at 48 h and 6 weeks after delivery by self-report method. Smart partial lease square version 3 was used to assess the validity and reliability of the model and the relationship between the variables.

Results

The findings of this study demonstrated that the COVID-19 anxiety during postpartum had a significant negative effect on the maternal-infant attachment (β = -0.183). Also, the maternal-infant attachment had a significant positive effect on the maternal competency (β = 0.48). Moreover, the conceptual model had good validity, reliability, quality and fit. And also the two variables of anxiety and mother-infant attachment together explained 25% of maternal competency.

Discussion

Mothers experience higher levels of the COVID-19 anxiety during pregnancy and postpartum; therefore, it is recommended that particular attention should be given to the psychological support of pregnant women during the COVID-19 pandemic and quarantine. Also, the COVID-19 anxiety during the postpartum period had a negative effect on the maternal-infant attachment and competency, which necessitates the need for the support of mother-infant relationship and providing the online training to promote the maternal-infant attachment patterns and maternal competency during the COVID-19 pandemic.

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.

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".

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.

Coping strategies and depression during the COVID-19 pandemic in pregnant women: a cross sectional study

BACKGROUND

Pregnant women are vulnerable to psychological problems depending on the adaptive capacities of their personality and coping strategies. This study aimed to investigate the association between coping strategies of pregnant women during the COVID-19 pandemic and depression.

METHODS

This web-based cross-sectional study was conducted in 2021 on 318 pregnant women in Amol, Iran. Data collection was performed via questionnaires (Brief cope, Edinburgh Postnatal Depression Scale, CDA, and Demographic questionnaire). The questionnaires were completed through the WhatsApp and Telegram applications. Data were analyzed using the hierarchical regression analysis and SPSS software (v. 21) at the significance level of 0.05.

RESULTS

About 40% of participants had depression. The most prevalent coping strategy used by pregnant women was the avoidance strategy. Hierarchical regression revealed that the coping strategy of avoidance was a significant predictor of depression (β = 0.226, p = 0.046) after controlling background characteristics.

CONCLUSIONS

The findings of this study suggest that avoidance style associated with depression in pregnant women. Therefore, obtaining further knowledge about impacts of coping strategies on pregnant women seems to be essential.

Effect of the Mindfulness-Based Stress Reduction program on stress, anxiety, and childbirth fear in pregnant women diagnosed with COVID-19

Objective

This study aims to examine the effectiveness of a live online Mindfulness-Based Stress Reduction (MBSR) program in preventing distress, anxiety and childbirth fear in pregnant women diagnosed with COVID-19.

Material and methods

Designed as a randomized-controlled trial, this study was performed with the participation of pregnant women who were diagnosed with COVID-19. The sample comprised 84 pregnant women, including 42 in the experimental group and 42 in the control group. The online MBSR program composed of eight sessions and lasting four weeks was provided to the pregnant women in the experimental group, whereas such an initiative was not provided to the control group. The data were collected via the Revised Prenatal Distress Questionnaire (NuPDQ), the Beck Anxiety Inventory (BAI), and the Childbirth Attitudes Questionnaire (CAQ).

Results

After the MBSR program, the mean NuPDQ, BAI and CAQ scores of the pregnant women in the experimental group were significantly lower than the mean scores of those in the control group (p < 0.001).

Conclusion

The online MBSR program may be utilized to reduce the distress, anxiety and childbirth fear levels of pregnant women diagnosed with COVID-19. By using the MBSR program, health professionals might improve the psychological well-being of pregnant women diagnosed with COVID-19.

Proportion of Late Pregnant Women with Anxiety Symptom under COVID-19 Pandemic in Japan

INTRODUCTION

The COVID-19 pandemic has caused stress and anxiety for pregnant women worldwide. We examined the anxiety symptom in Japanese women during pregnancy using a self-administered questionnaire under the COVID-19 pandemic.

METHODS

Between April 2020 and March 2021 (2020, the COVID-19 pandemic), we asked 248 Japanese women without history of mental disorders who delivered singleton neonates at 37-41 weeks' gestation to answer the two-item generalized anxiety disorder scale (GAD-2) at first, second, and third trimesters of gestation. We also asked 311 women with the same situation between January 2019 and December 2019 (2019) as control.

RESULTS

The women with anxiety symptom were common during the first trimester of gestation irrespective of COVID-19 pandemic. In 2019, the proportion of the women with anxiety symptom decreased as the trimester of pregnancy progressed (p < 0.01); however, in 2020, the proportion of women with anxiety symptom did not decrease during pregnancy. During the late pregnancy, the proportions of women with anxiety symptom in 2020 were significantly higher than those in 2019 (p < 0.01) regardless of maternal parity or age in Japan.

CONCLUSION

The COVID-19 pandemic seemed to prevent the decrease in anxiety symptom that should decrease as pregnancy progresses regardless of maternal parity or age in Japan.

The sustained adverse impact of COVID-19 pandemic on mental health among pregnant women in Sri Lanka: a reassessment during the second wave

Objective

To study the change in trend of antenatal mental health and associated factors among a cohort of pregnant women during the second wave of COVID-19 using Hospital Anxiety and Depression Scale (HADS). Previous study using the same scale, during the first wave reported a higher prevalence of anxiety and depression.

Results

A descriptive cross-sectional study was carried out at the two large maternity hospitals in Colombo, Sri Lanka: Castle Street Hospital for Women (CSHW) and De Soysa Hospital for Women (DSHW). Consecutively recruited 311 women were studied. Out of which, 272 (87.5%) were having uncomplicated pregnancies at the time of the survey and 106 (34.1%) were either anxious, depressed, or both. Prevalence of anxiety was 17.0% and depression 27.0%. Overall, continuing COVID-19 pandemic increased antenatal anxiety and depression. The trend was to aggravate depression more intensively compared to anxiety in this cohort of women studied. Special support is needed for pregnant mothers during infectious epidemics taking more attention to antenatal depression.

The COVID-19 Pandemic: How Does it Affect Pregnant Women?

BACKGROUND: The COVID-19 pandemic has a severe impact globally, not limited to general health and mental health. Pregnant women are a vulnerable group. Hormonal changes that occur during pregnancy significantly affect physical and psychological health. AIM: The purpose of this study was to explore the anxiety felt by pregnant women holistically about their pregnancy during the COVID-19 pandemic. METHODOLOGY: This study is qualitative phenomenological research with a naturalistic approach. The informants consisted of 20 pregnant women from three different islands and provinces in Indonesia in February 2021. They were selected to obtain heterogeneous data based on education level, gestational age, urban-rural areas, culture, and religion. The collection of information data used semi-structured interview guidelines with 12 questions. Data analysis used qualitative content analysis to explore pregnant women’s anxiety with a similar meaning using software (Nvivo release 12). RESULTS: Five domains caused anxiety for pregnant women related to the COVID-19 pandemic, such as feeling worried about being infected with COVID-19, the impact on health during pregnancy, the family economy, the circulating information around the community, and unfulfilled spiritual needs in utilizing places of worship. CONCLUSION: The COVID-19 pandemic influenced pregnant women in a bio-psycho-socio-cultural manner, both about themselves, their fetuses, and their families. Anxiety that mothers feel during the pregnancy process needs proper treatment to protect the mothers’ health and babies’ well-being in the future. Thus, early detection or screening of anxiety during the COVID-19 pandemic in health services is necessary.

Determinants of Pregnancy-Related Anxiety among Women Attending Antenatal Checkup at Public Health Institutions in Debre Markos Town, Ethiopia

BACKGROUND

Pregnancy-related anxiety has been associated with many pregnancy adverse outcomes including preterm birth, low birth weight, postpartum depression, and resulting in long-term sequels on the child's emotional, cognitive, and behavioral development. This study is aimed at assessing the magnitude of pregnancy-related anxiety and associated factors among pregnant women attending antenatal checkup at Debre Markos town public health institutions, Northwest Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among 423 pregnant women at Debre Markos town, Northwest Ethiopia, from February 1^st to March 30^th, 2021. A systematic random sampling technique was used to select the study participants. Data were collected sing a structured, pretested, and interviewer-administered questionnaire. The collected data were entered with Epi-data version 4.6 and then exported to SPSS version 23. Both bivariable and multivariable logistic regression analyses were undertaken to identify significantly associated variables with pregnancy-related anxiety. The adjusted odds ratio (AOR) with its 95% confidence interval (CI) at a p value of ≤0.05 was used to claim statistical association.

RESULT

In this study, a total of 408 pregnant women participated, giving a 96.4% response rate. The prevalence of pregnancy-related anxiety was found to be 43.9% (95% CI: 39.5, 49.2). Having no formal education (AOR = 3.37; 95% CI: 1.32, 8.58), primigravida (AOR = 1.94; 95% CI: 1.17, 3.24), intimate partner violence (AOR = 2.88; 95% CI: 1.47, 5.64), and poor social support (AOR = 2.05; 95% CI: 1.18, 3.56) was significantly associated with pregnancy-related anxiety.

CONCLUSION

In this study, the prevalence of pregnancy-related anxiety was found to be high when compared to other study findings. The regional educational department should give emphasis for gender pedagogies which pay attention to the specific learning needs of girls. In addition, interventions on violence against women and social support for the women may reduce the problem.

[Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed - Update November 2021 (Long Version)]

Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have given birth, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the long version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).

Depression Among HIV-Positive Pregnant Women at Northwest Amhara Referral Hospitals During COVID-19 Pandemic

Background

Depression is the most common mental health disorder among HIV-positive pregnant mothers, which increases mortality, poor quality of life; it also increases the burden of disease. Depression hurts birth outcomes and maternal health.

Objective

To assess depression and its associated factors among HIV-positive pregnant women attending antenatal care at Northwest Amhara referral hospitals, 2021.

Methods

An institution-based cross-sectional study was conducted among 291 HIV-positive pregnant mothers from March 15, 2021 to April 30, 2021 at Northwest Amhara referral hospitals. Census was applied to reach the study participants. An interviewer-administered questionnaire was used for data collection. A binary logistic regression was conducted to see the relationship between dependent variables and independent. Those variables having a p-value of ≤0.05 were found to be statistically associated with the response.

Results

Depression among HIV-positive pregnant women was found to be 28.7% [95% CI (24.8–33.40)] with a response rate of 96.04. Age ≥30 years [AOR = 1.32, 95% CI (1.24–3.35)], urban residency [AOR = 1.76, 95% CI (1.57–4.61)], having first pregnancy <18 years [AOR = 3.82, 95% CI (1.54–17.34)], known HIV serostatus during pregnancy [AOR = 1.29, 95% CI (1.08–2.47)], and COVID-19-related knowledge [AOR = 0.32, 95% CI (0.12–1.12) were significantly associated with depression.

Conclusions and Recommendations

Nearly one-third of the pregnant women attending antenatal care were depressed. The age of the mother, residence, known HIV serostatus during pregnancy, age in the first pregnancy, and COVID-19-related knowledge were significantly associated with depression, and strengthening the existing care provided was the recalled interventions to combat antenatal depression during the COVID-19 pandemic.

Anxiety among pregnant women during the COVID-19 pandemic in India - A multicentric study

While higher anxiety during antenatal period cause several maternal and foetal health related complications, lower anxiety levels are found to be associated with lesser "precautionary behaviours" and consequently greater risk of infection, during the COVID-19 pandemic. In this study, we aimed to assess rates and determinants of generalized anxiety at the time of the pandemic as well as anxiety that was specific to the context of being pregnant during the COVID-19 pandemic. (COVID-19-antenatal anxiety) in Indian women. This hospital-based, cross-sectional study using face-to-face interviews was conducted at antenatal clinics of five medical college hospitals in India. The Generalized Anxiety Disorder-7 scale (GAD -7) and a customized scale to assess antenatal COVID-19 anxiety along with other tools that assessed social support and COVID-19-risk perception were administered to 620 pregnant women. We found that the percentage of women with moderate or severe anxiety based on GAD -7 was 11.1%. Multivariate analysis showed that higher COVID-19-risk perception, greater antenatal COVID-19 anxiety and lower perceived support significantly predicted moderate and severe generalized anxiety. Greater number of weeks of gestation, lower education, semiurban habitat and lower perceived social support were significant predictors of antenatal COVID-19 anxiety. We conclude that the rates of anxiety in pregnant women though not very high, still warrant attention and specific interventions.

Body Image During Pregnancy in the Era of Coronavirus Disease 2019: The Role of Heterogeneous Patterns of Perceived Social Support

Objective: The aim of this study was to explore the profiles of pregnant women on perceived social support with regard to sociodemographic variables, coronavirus disease 2019 (COVID-19)-related distress issues, and body image. We compared the aforementioned relationships within the study variables between pregnant women and a control group of non-pregnant women. Method: The study sample comprised 345 women, 157 pregnant women, and 188 women in the control group. Participants filled out paper-and-pencil or online psychometric questionnaires to assess the variables analyzed in our research. Results: Latent profile analysis revealed six profiles of pregnant women based on perceived social support, which varied in terms of body image evaluation. The high-support profile differed from the profiles with the lowest scores in all support domains. Significant differences in body image between the profiles of pregnant women and the control group were noted. Conclusion: Understanding the mechanisms through which women can attain more body satisfaction during pregnancy is an important research topic that can inspire planning for more effective psychological help, especially in the context of the COVID-19 pandemic and related psychological distress.

Perceived Stress, Resilience, and Anxiety Among Pregnant Chinese Women During the COVID-19 Pandemic: Latent Profile Analysis and Mediation Analysis

Objective: The coronavirus disease 2019 (COVID-19) pandemic has posed a major threat to pregnant women's mental health. This study aimed to characterize the patterns of perceived stress in pregnant Chinese women during the COVID-19 pandemic, to examine the profile differences on anxiety and resilience, and to investigate whether the differences in these profiles on anxiety were mediated by resilience.

Methods: From February 28, 2020 to April 26, 2020, a sample of 2,116 pregnant Chinese women who participated in online crisis interventions completed an online self-reporting questionnaire assessing their demographic characteristics, perceived stress, resilience, and anxiety.

Results: Latent profile analysis (LPA) on two stress dimensions [perceived helplessness (HEL) and perceived self-efficacy (SEL)] indicated four perceived stress profiles: adaptive (33.7% of the sample), resistant (44.6%), insensitive (19.1%), and sensitive (2.6%). The women with both adaptive and insensitive profiles had the lowest levels of anxiety, whereas those with the resistant profile had the lowest levels of resilience. Multicategorical mediation analysis showed that resilience partially mediated the differences in the pregnant women's anxiety between the adaptive/insensitive and resistant profile.

Conclusion: This study showed the heterogeneity in the perceived stress patterns of pregnant women during the COVID-19 pandemic, revealing the internal mechanisms of pregnant women's anxiety using a person-centered approach, and provided initial evidence guiding the development of differentiated stress interventions to alleviate pregnant women's anxiety during the pandemic.

Stress, Coping, and Psychiatric Symptoms in Pregnant Women in Outpatient Care During the 2021 Second-Wave COVID-19 Pandemic

Aims: Women face many sources of stress throughout their lives, and some periods are particularly sensitive; pregnancy is one of them. The COVID-19 pandemic is a likely source of additional stress for pregnant women. Moreover, there is evidence that pregnant women have experienced high levels of anxiety and depression symptoms during the pandemic. Our study aimed to evaluate the association of pregnancy-specific stress, pandemic-related stress, and coping strategies with anxiety, depressive and obsessive-compulsive symptomatology in Italian women during the second wave of the COVID-19 pandemic (December 2020-June 2021). We also investigated whether there were differences in these levels of psychopathology compared to a prior study conducted during the first pandemic wave (April-August 2020) in Italian pregnant women. Methods: We assessed 325 pregnant women receiving outpatient prenatal care, using the Revised Prenatal Distress Questionnaire (NuPDQ), Pandemic-Related Pregnancy Stress Scale (PREPS), the Revised Prenatal Coping Inventory (NuPCI), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2), and Obsessive-Compulsive Disorder (OCD) screening. The main analysis was conducted comparing multiple logistic regression models predicting each psychopathological outcome from specific covariates and NuPDQ, PREPS, and NuPCI scores. Results: 42.8% of the sample reported significant levels of anxiety, while 10.3% was positive on depression screening and 13.1% on OCD screening. No significant difference was found in the prevalence of high anxiety, depression, or OCD screening scores compared with the first pandemic wave. Controlling for covariates, we found that GAD-7 and PHQ-2 scores were predicted by pregnancy-specific stress; positive OCD screening was not. The model of high anxiety was improved by adding pandemic-related stress as a predictor (in particular, feeling unprepared for delivery and postpartum). Finally, coping strategies (avoidance, spiritual coping, and planning-preparation) significantly improved prediction of all three psychopathological outcomes. Conclusions: The present study suggests the importance of pregnancy-related stress, COVID-19 pandemic stress, and of coping strategies in counteracting or contributing to psychiatric symptomatology during the current pandemic.