PLoS One

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. 2021 Apr 21;16(4):e0249780.
 doi: 10.1371/journal.pone.0249780. eCollection 2021.

A cross-national study of factors

associated with women's perinatal
mental health and wellbeing during
the COVID-19 pandemic
Archana Basu 1 2, Hannah H Kim 1, Rebecca Basaldua 1, Karmel W Choi 2, Lily Charron 3, Nora
Kelsall 1, Sonia Hernandez-Diaz 1, Diego F Wyszynski 4, Karestan C Koenen 1 2
Affiliations expand
Abstract

Pregnant and postpartum women face unique challenges during the COVID-19
pandemic that may put them at elevated risk of mental health problems. However, few
large-scale and no cross-national studies have been conducted to date that investigate
modifiable pandemic-related behavioral or cognitive factors that may influence mental
health in this vulnerable group. This international study sought to identify and measure
the associations between pandemic-related information seeking, worries, and
prevention behaviors on perinatal mental health during the COVID-19 pandemic. An
anonymous, online, cross-sectional survey of pregnant and postpartum women was
conducted in 64 countries between May 26, 2020 and June 13, 2020. The survey,
available in twelve languages, was hosted on the Pregistry platform for COVID-19
studies (https://corona.pregistry.com) and advertised in social media channels and
online parenting forums. Participants completed measures on demographics, COVID-19
exposure and worries, information seeking, COVID-19 prevention behaviors, and mental
health symptoms including posttraumatic stress via the IES-6, anxiety/depression via the
PHQ-4, and loneliness via the UCLA-3. Of the 6,894 participants, substantial proportions
of women scored at or above the cut-offs for elevated posttraumatic stress (2,979
[43%]), anxiety/depression (2,138 [31%], and loneliness (3,691 [53%]). Information
seeking from any source (e.g., social media, news, talking to others) five or more times
per day was associated with more than twice the odds of elevated posttraumatic stress
and anxiety/depression, in adjusted models. A majority of women (86%) reported being
somewhat or very worried about COVID-19. The most commonly reported worries were
related to pregnancy and delivery, including family being unable to visit after delivery
(59%), the baby contracting COVID-19 (59%), lack of a support person during delivery
(55%), and COVID-19 causing changes to the delivery plan (41%). Greater worries
related to children (i.e., inadequate childcare, their infection risk) and missing medical
appointments were associated with significantly higher odds of posttraumatic stress,
anxiety/depression and loneliness. Engaging in hygiene-related COVID-19 prevention
behaviors (face mask-wearing, washing hands, disinfecting surfaces) were not related to
mental health symptoms or loneliness. Elevated posttraumatic stress,
anxiety/depression, and loneliness are highly prevalent in pregnant and postpartum
women across 64 countries during the COVID-19 pandemic. Excessive information
seeking and worries related to children and medical care are associated with elevated
symptoms, whereas engaging in hygiene-related preventive measures were not. In
addition to screening and monitoring mental health symptoms, addressing excessive
information seeking and women's worries about access to medical care and their
children's well-being, and developing strategies to target loneliness (e.g., online support
groups) should be part of intervention efforts for perinatal women. Public health
campaigns and medical care systems need to explicitly address the impact of COVID-19
related stressors on mental health in perinatal women, as prevention of viral exposure
itself does not mitigate the pandemic's mental health impact.
 Pregnancy-related anxiety during COVID-19: a
nationwide survey of 2740 pregnant women
Arch Womens Ment Health
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. 2020 Dec;23(6):757-765.
 doi: 10.1007/s00737-020-01073-5. Epub 2020 Sep 29.

Abstract

The aim of this study is to explore the impact of the COVID-19 pandemic on pregnant
women's anxiety and identify factors most strongly associated with greater changes in
anxiety. An anonymous, online, survey of pregnant women (distributed April 3-24, 2020)
included a modified pregnancy-related anxiety scale (PRAS) reflecting respondents'
perception of pregnancy anxiety before COVID-19 and a current assessment of
pregnancy-related anxiety. The difference between these scores was used as the
outcome variable. Data were analyzed using bivariate and multivariate linear regression
analyses. Two thousand seven hundred forty pregnant women from 47 states completed
the survey. 25.8% (N = 706) stopped in-person visits, 15.2% used video visits (N = 415),
and 31.8% (N = 817) used phone visits for prenatal care as a result of COVID-19. Those
planning a hospital birth dropped from 2641 (96.4%) to 2400 (87.7%) following COVID-
19. More than half of women reported increased stress about food running out (59.2%,
N = 1622), losing a job or household income (63.7%, N = 1745), or loss of childcare
(56.3%, N = 1543). More than a third reported increasing stress about conflict between
household members (37.5%, N = 1028), and 93% (N = 2556) reported increased stress
about getting infected with COVID-19. Slightly less than half of respondents (either
selves or family members) were healthcare workers (41.4%, N = 1133) or worked in
essential services (45.5%, N = 1246). In multivariate analysis, those reporting higher
agreement with COVID-19-related stressors had greater changes in pre- to post-COVID-
19 pregnancy-related anxiety. The COVID-19 pandemic is profoundly affecting pregnant
women's mental health, and factors independent of pregnancy appear to be driving
changes in pregnancy-specific anxiety.