COVID Related Psychological Well-being among Pregnant Mother: A Systematic Review of Recent Evidence

Sahar Raza¹ and Samia Amin^2*
*Correspondence: Samia Amin, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia, Email:

Keywords

COVID • Stress • Anxiety • Depression • Postpartum • Pregnant

Introduction

Background

The novel coronavirus rapidly spread in different countries across the globe that has reached the status of a pandemic [1]. Such an ongoing pandemic significantly impacts health and wellbeing globally [1]. Patients with chronic diseases such as cerebrovascular, liver, and renal disease, or cancer had a greater probability of mortality [2]. Additionally, physical distancing, social isolation, prolonged lockdowns, and lack of social human interaction aggravated several psychological health conditions such as depression and anxiety which are the most critical public health concerns at the current date [3]. This pandemic situation may have been challenging for maternal psychological health. The extensive physiological changes such as unprecedented hormonal fluctuations increase the vulnerability of pregnant women to psychological disorders. Although recent evidence suggests that the overall morbidity and mortality risk of COVID-19 to pregnant women is low, however, pregnant mothers with COVID-19 might experience a higher risk of premature birth and caesarean delivery with severe psychological consequences [4,5].

As the pandemic is still unfortunately under progression, there are limited data regarding the psychological characteristics of diverse patients including pregnant mother. Pregnancy-related COVID-19 cases with psychological concerns such as anxiety and depression have been reported all over the world [6]. However, as the data is evolving, there are still various factors that require further robust research. This paper presents a review of available literature to understand the dynamics of psychological impacts in pregnancy at different population-level alongside factors associated with mental health conditions in those studies in the context of COVID-19.

Methods

A systematic search of the literature was performed using PubMed, EMBASE, PsycINFO, and CINAHL with several combinations of the following and related search words: pregnant, postpartum depression, postpartum psychosis, puerperal psychosis, COVID, COVID 19, pandemic, and SARS CoV-2. We identified relevant studies published between 1 January 2020 and 31 December 2021. For this current review, we have held the search date for studies published since January 2020 because it was initially reported to the World Health Organization (WHO) on December 31, 2019, and on January 30, 2020, the WHO declared the COVID-19 outbreak a global health emergency [7].

Studies were included if they were in English, published in peer-reviewed journals, and sample populations were women (either antenatal or postnatal period of pregnancy status). The reference lists of all relevant articles were also screened to ensure all eligible studies were included.

The search identified 23 studies; duplicates or unrelated articles were excluded at the title and abstract screening phase. We screened the full text of 11 studies and a total of 4 studies were eligible for inclusion in this review. Two reviewers independently assessed the included studies; the lead author performed the data extraction and reviewed the data extraction table for accuracy. A descriptive synthesis was performed from the individual studies to support the narrative.

Results and Discussion

After full text review, 4 studies were included in the analysis (Table 1). All the studies used cross-sectional designs that were conducted in the United States, China, and Italy. A total of 1,742 participants were included in all 4 studies. The mean age of the study participants was 31.5 years. Only one study did not report conflict of interest. Two studies declared the funding source.

Specifically, Ran A, et al. [8] studied the risk factors of postpartum depression and health care needs among Chinese postpartum women during the COVID-19 pandemic (data collected May to July 2020). The incidence of postpartum depressive symptoms was 56.9% (119 of 209) and the perceived stress was the influencing factors of postpartum depression (adjusted R2=0.432, F=23.611, p <.001). Fewer than half of the women knew a lot about the knowledge of COVID-19 (48.8%). There was 52.2% (109 of 209) of the women expressed concern about COVID-19 infection, and 69.4% (145 of 209) of the women asked for help voluntarily when they were in panic or anxiety during the pandemic. There was no statistically significant difference in Edinburgh Postpartum Depression Scale (EPDS) scores among postpartum women of different levels of knowledge about COVID-19 (p=0.108).and the behaviour of asking for help in times of panic or anxiety (p=0.278). Pearson correlation analysis found that postpartum depression score was positively correlated with perceived stress level (p <.001). The higher the perceived stress, the higher the level of postpartum depression (t=11.348, p <.001) during the COVID-19 pandemic.

The largest study population of 715 United States pregnant women was evaluated by Liu J et al. [9] to measure associations between COVID-19– related experiences and psychological outcomes (i.e., depressive symptoms, thoughts of self-harm, and anxiety). The data was collected in May 2020. Strict social distancing was positively associated with depression. Approximately 36% and 22% of women suffered from probable depression and anxiety respectively during pregnancy. Remarkably, one in five pregnant women reported thoughts of harming themselves. Women with probable depression were more likely to report thoughts of self-harm than women who were not depressed (53% vs. 1.3%). Additionally, losing a family member because of COVID-19 was positively associated with thoughts of self-harm and working from home were inversely associated with thoughts of self-harm.

Similarly, Molgora S, et al. [10] Investigated Italian women’s psychological well-being during pregnancy and in the first months after childbirth (data collected March to May 2020). Both the expectant mother and postpartum women were scored significant range for state (triggered as a response to a stressful situation) and trait (triggered because of a person’s predisposition to react anxiously to a situation) anxiety. Moreover 34.2% (133) of expectant mother and 26.3% (49) of postpartum women had clinically significant levels of depression. The medical appointment and check-up, epidural analgesia, partners’ presence at delivery, and hospitalization were mentioned due to COVID restriction policy (Table 1).