Pregnant Women at Increased Risk for Anxiety and Depression During COVID-19 Restrictions

Pregnant women have experienced increased anxiety and depression during the first waves of lockdowns due to the COVID-19 pandemic. These findings, from a prospective cohort study, were published in Acta Obstetricia et Gynecologica Scandinavica.

Researchers from Hospital Universitari Vall d’Hebron in Spain recruited 204 pregnant women from March 27 to May 4, 2020, during which time strict lockdowns were in effect. The women were assessed by telephone using these instruments: the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), and the Medical Outcomes Study Social Support Survey (MOS-SSS). Participants were stratified by lockdown group 1 (n=91; March 27-April 14) and lockdown group 2 (n=74; April 15-May 4).

Participants were aged mean 32.3±0.8 years, 65% had a low-risk pregnancy, 9% had a mental health disorder, 4% had previous depression, and 27%, 40%, and 33% were in their first, second, and third trimesters, respectively.

An EPDS score ³10 was reported by 37.8% (95% CI, 30.5%-45.7%), a STAIs (state of anxiety) ³40 by 59.6% (95% CI, 49.8%-68.8%), and STAIt (trait of anxiety) ³40 by 58.7% (95% CI, 48.9%-67.9%). Compared with the general population, pregnant women reported more depression (38% vs 18.7%) and anxiety (59% vs 21.6%), respectively.

Stratified by progression of pregnancy, women in the first or second trimester had significantly higher EPDS scores than those in their third (9.0 vs 6.0; P =.031). Women did not differ for STAIs (P =.253) or STAIt (P =.234) scores on the basis of trimester.

Stratified by lockdown period, women did not differ for EPDS (P =.097), STAIs (P =.518), or STAIt (P =.072) scores on the basis of earlier or later lockdowns.

Symptoms of depression were positively associated with body mass index (b; 0.15, 95% CI, 0.036-0.332; P =.015) and negatively associated with a mental health disorder (b; -0.3189, 95% CI, -5.707 to -0.672; P =.013) and MOS-SSS score (b; -0.149, 95% CI, -0.211 to -0.087; P =.000).

Symptoms of anxiety, as assessed by the STAIs, were negatively associated with a mental health disorder (b; -5.997, 95% CI, -11.481 to -0.512; P =.032), MOS-SSS score (b; -0.180, 95% CI, -0.348 to -0.013; P =.035), and among Latin American women (b; -10.578, 95% CI, -20.647 to -0.510; P =.040) and as assessed by the STAIt, were negatively associated with MOS-SSS score (b; -0.249, 95% CI, -0.394 to -0.105; P =.001) and a mental health disorder (b; -7.022, 95% CI, -12.334 to -1.710; P =.010).

This study may have been biased by recruiting women during their hospital visits at a time when many women were not attending their doctors’ visits out of fear, indicating these results may be an underestimation.

These findings indicated pregnant women were at increased risk for experiencing symptoms of anxiety and depression during the COVID-19 lockdown, highlighting the importance of providing mental health care to pregnant women.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Brik M, Sandonis MA, Fernández S, et al. Psychological impact and social support in pregnant women during lockdown due to SARS-CoV2 pandemic: A cohort study. Acta Obstet Gynecol Scand. Published online February 2, 2021. doi:10.1111/aogs.14073