Uptrend in Distress and Psychiatric Symptomatology in Pregnant Women During the Coronavirus Disease 2019 Pandemic

Acta Obstet Gynecol Scand. 2020 Jul;99(7):848-855. doi: 10.1111/aogs.13925. Epub 2020 Jun 3.

Abstract

Introduction: Prenatal maternal distress has a negative impact on the course of pregnancy, fetal development, offspring development, and later psychopathologies. The study aimed to determine the extent to which the coronavirus disease 2019 (COVID-19) pandemic may aggravate the prenatal distress and psychiatric symptomatology of pregnant women.

Material and methods: Two cohorts of pregnant volunteer women were evaluated, one that was recruited before the COVID-19 pandemic (n = 496) through advertisements in prenatal clinics in Quebec, Canada, from April 2018 to March 2020; the other (n = 1258) was recruited online during the pandemic from 2 April to 13 April 2020. Prenatal distress and psychiatric symptomatology were measured with the Kessler Distress Scale (K10), Post-traumatic Checklist for DSM-5 (PCL-5), Dissociative Experiences Scale (DES-II), and Positive and Negative Affect Schedule (PANAS).

Results: The 1754 pregnant women (Mage = 29.27, SD = 4.23) were between 4 and 41 gestational weeks (M = 24.80, SD = 9.42), were generally educated (91.3% had post-high-school training), and financially well-resourced (85.3% were above the low-income cut-off). A multivariate analysis of covariance controlling for age, gestational age, household income, education, and lifetime psychiatric disorders showed a large effect size (ES) in the difference between the two cohorts on psychiatric symptoms (Wilks' λ = 0.68, F6,1400 = 108.50, P < .001, partial η2 = 0.32). According to post-hoc analyses of covariance, the COVID-19 women reported higher levels of depressive and anxiety symptoms (ES = 0.57), dissociative symptoms (ES = 0.22 and ES = 0.25), symptoms of post-traumatic stress disorder (ES = 0.19), and negative affectivity (ES = 0.96), and less positive affectivity (ES = 0.95) than the pre-COVID-19 cohort. Women from the COVID-19 cohort were more likely than pre-COVID-19 women to present clinically significant levels of depressive and anxiety symptoms (OR = 1.94, χ2 [1] = 10.05, P = .002). Multiple regression analyses indicated that pregnant women in the COVID-19 cohort having a previous psychiatric diagnosis or low income would be more prone to elevated distress and psychiatric symptoms.

Conclusions: Pregnant women assessed during the COVID-19 pandemic reported more distress and psychiatric symptoms than pregnant women assessed before the pandemic, mainly in the form of depression and anxiety symptoms. Given the harmful consequences of prenatal distress on mothers and offspring, the presently observed upsurge of symptoms in pregnant women calls for special means of clinical surveillance.

Keywords: anxiety; coronavirus disease 2019; depression; mental health; mothers; post-traumatic stress disorder; pregnancy; prenatal.

MeSH terms

  • Adult
  • Anxiety* / diagnosis
  • Anxiety* / epidemiology
  • Anxiety* / etiology
  • Anxiety* / physiopathology
  • Betacoronavirus / isolation & purification
  • Canada / epidemiology
  • Coronavirus Infections* / diagnosis
  • Coronavirus Infections* / epidemiology
  • Coronavirus Infections* / psychology
  • Depression* / diagnosis
  • Depression* / epidemiology
  • Depression* / etiology
  • Depression* / physiopathology
  • Female
  • Humans
  • Pandemics*
  • Pneumonia, Viral* / diagnosis
  • Pneumonia, Viral* / epidemiology
  • Pneumonia, Viral* / psychology
  • Pregnancy
  • Pregnancy Complications* / diagnosis
  • Pregnancy Complications* / epidemiology
  • Pregnancy Complications* / physiopathology
  • Pregnancy Complications* / psychology
  • Pregnant Women / psychology*
  • Psychiatric Status Rating Scales
  • Stress Disorders, Post-Traumatic / etiology
  • Stress Disorders, Post-Traumatic / prevention & control
  • Stress, Psychological* / diagnosis
  • Stress, Psychological* / epidemiology
  • Stress, Psychological* / etiology
  • Stress, Psychological* / physiopathology

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2