OBJECTIVE: To assess risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic using Mind-COVID, a prospective cross-sectional study that compares outcomes in middle-income economies and high-income economies. METHODS: A total of 7102 pregnant women from 12 high-income economies and nine middle-income economies were included. The web-based survey used two standardized instruments, General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). RESULT: Pregnant women in high-income economies reported higher PHQ-9 (0.18 standard deviation [SD], P < 0.001) and GAD-7 (0.08 SD, P = 0.005) scores than those living in middle-income economies. Multivariate regression analysis showed that increasing PHQ-9 and GAD-7 scales were associated with mental health problems during pregnancy and the need for psychiatric treatment before pregnancy. PHQ-9 was associated with a feeling of burden related to restrictions in social distancing, and access to leisure activities. GAD-7 scores were associated with a pregnancy-related complication, fear of adverse outcomes in children related to COVID-19, and feeling of burden related to finances. CONCLUSIONS: According to this study, the imposed public health measures and hospital restrictions have left pregnant women more vulnerable during these difficult times. Adequate partner and family support during pregnancy and childbirth can be one of the most important protective factors against anxiety and depression, regardless of national economic status.

Centro Hondureño De Medicina Fetal Honduras

Chair and Department of Gynecology and Obstetrics Faculty of Health Sciences in Katowice Medical University of Silesia Poland

Clinical Research Division National Institute of Perinatology Mexico City Mexico

Department of Clinical and Experimental Sciences University of Brescia Italy

Department of Fetal Medicine Taiji Clinic Taipei Taiwan

Department of Obstetrics and Gynaecology Hospital Tengku Ampuan Afzan Kuantan Malaysia

Department of Obstetrics and Gynaecology Prince of Wales Hospital The Chinese University of Hong Kong Shatin Hong Kong SAR

Department of Obstetrics and Gynecology Pomeranian Medical University Szczecin Poland

Department of Obstetrics and Gynecology Wayne State University School of Medicine Detroit Michigan USA

Department of Obstetrics Chang Gung Memorial Hospital Taipei Taiwan

Department of Obstetrics Medical School Charité University Medicine Berlin Germany

Department of Physiology Wayne State University School of Medicine Detroit Michigan USA

Department of Reproductive Health Center of Postgraduate Medical Education Warsaw Poland

Division of Obstetrics and Gynecology Department of Clinical Science Intervention and Technology Karolinska Institutet Stockholm Sweden

Fetal Medicine Center 1st Medical Faculty of the Charles University and General Teaching Hospital Prague Czech Republic

Fetal Medicine Mexico A C Tabasco Mexico

Hospital Universitario Austral Buenos Aires Argentina

Hospital Universitario de Torrejón School of Medicine Universidad Francisco de Vitoria Madrid Spain

Institute of Philosophy and Sociology of the Polish Academy of Sciences Warsaw Poland

Maternal Fetal Medicine Specialist Sarawak General Hospital Kuching Malaysia

Médecine et Chirurgie Foetales Maternité Hôpital Universitaire Necker Enfants Malades Assistance Publique Hôpitaux de Paris Université de Paris France

Meir Medical Center Tel Aviv University Israel

Nicolaus Copernicus University in Toruń Collegium Medicum in Bydgoszcz The Faculty of Health Sciences Department of Perinatology Gynacology and Gynecologic Oncology Toruń Poland

Office of Women's Health Integrative Biosciences Center Wayne State University Detroit Michigan USA

Research Unit Department of Obstetrics and Gynecology Hospital Nacional Edgardo Rebagliati Martins Lima Peru

Women's Health and Perinatology Research Group Institute of Clinical Medicine Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway

Women's Health and Perinatology Research Group Institute of Clinical medicine UiT The Arctic University of Norway Tromsø Norway; Department of Obstetrics and Gynecology University Hospital of North Norway Tromsø Norway

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