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

See more in PubMed

Palacios Cruz M, Santos E, Velázquez Cervantes MA, León Juárez M. COVID‐19, a worldwide public health emergency. Rev Clin Esp (English Edition). 2021;221(1):55‐61. PubMed PMC

Pfefferbaum B, North CS. Mental health and the Covid‐19 pandemic. N Engl J Med. 2020;383(6):510‐512. PubMed

Kajdy A, Feduniw S, Ajdacka U, et al. Risk factors for anxiety and depression among pregnant women during the COVID‐19 pandemic: a web‐based cross‐sectional survey. Medicine (Baltimore). 2020;99:e21279. PubMed PMC

Nanjundaswamy MH, Shiva L, Desai G, et al. COVID‐19‐related anxiety and concerns expressed by pregnant and postpartum women—a survey among obstetricians. Arch Womens Ment Health. 2020;23:787‐790. PubMed PMC

Yang R, Mei H, Zheng T, et al. Pregnant women with COVID‐19 and risk of adverse birth outcomes and maternal‐fetal vertical transmission: a population‐based cohort study in Wuhan, China. BMC Med. 2020;18:1‐7. PubMed PMC

Aksoy Derya Y, Altiparmak S, AkÇa E, GÖkbulut N, Yilmaz AN. Pregnancy and birth planning during COVID‐19: the effects of tele‐education offered to pregnant women on prenatal distress and pregnancy‐related anxiety. Midwifery. 2021;92:102877. PubMed PMC

Chasson M, Taubman ‐ Ben‐Ari O, Abu‐Sharkia S. Jewish and Arab pregnant women's psychological distress during the COVID‐19 pandemic: the contribution of personal resources. Ethn Health. 2021;26:139‐151. PubMed

Corbett GA, Milne SJ, Hehir MP, Lindow SW, O'connell MP. Health anxiety and behavioural changes of pregnant women during the COVID‐19 pandemic. Eur J Obstet Gynecol Reprod Biol. 2020;249:96‐97. PubMed PMC

Lebel C, MacKinnon A, Bagshawe M, Tomfohr‐Madsen L, Giesbrecht G. Elevated depression and anxiety symptoms among pregnant individuals during the COVID‐19 pandemic. J Affect Disord. 2020;277:5‐13. PubMed PMC

Salehi L, Rahimzadeh M, Molaei E, Zaheri H, Esmaelzadeh‐Saeieh S. The relationship among fear and anxiety of COVID‐19, pregnancy experience, and mental health disorder in pregnant women: a structural equation model. Brain Behav. 2020;10:e01835. doi:10.1002/brb3.1835 PubMed DOI PMC

Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet E‐surveys (CHERRIES). J Med Internet Res. 2004;6:e132. PubMed PMC

Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. PubMed PMC

Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD‐7. Arch Intern Med. 2006;166:1092‐1097. PubMed

Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self‐report version of PRIME‐MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282:1737‐1744. PubMed

World Bank Country and Lending Groups – World Bank Data Help Desk. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519‐world‐bank‐country‐and‐lending‐groups?fbclid=IwAR25p6tE39M3Ao5BjD0bx‐_uUqe‐yWBmTYdh6z_Aq5P5SPwDAA‐uJmRiOho (accessed June 20, 2021).

Asparouhov T, Muthén B. Multiple‐group factor analysis alignment. Struct Equ Model Multidiscip J. 2014;21:495‐508.

Muthén LK, Muthén BO. Mplus user's guide. Eighth; 2017.

Ahrens A, Hansen CB, Schaffer M. LASSOPACK: Stata module for lasso, square‐root lasso, elastic net, ridge, adaptive lasso estimation and cross‐validation. 2019.

StataCorp . Stata Statistical Software. StataCorp LLC; 2021.

WHO . Mental health and psychosocial considerations during the COVID‐19 outbreak. https://www.who.int/docs/default‐source/coronaviruse/mental‐health‐considerations.pdf (accessed June 20, 2021).

Chmielewska B, Barratt I, Townsend R, et al. Effects of the COVID‐19 pandemic on maternal and perinatal outcomes: a systematic review and meta‐analysis. Lancet Glob Health. 2021;9:e759‐e772. PubMed PMC

Chivers BR, Garad RM, Boyle JA, Skouteris H, Teede HJ, Harrison CL. Perinatal distress during COVID‐19: thematic analysis of an online parenting forum. J Med Internet Res. 2020;22(9):e22002. doi:10.2196/22002 PubMed DOI PMC

Poon LC, Abramowicz JS, Dall'Asta A, et al. ISUOG safety committee position statement: safe performance of obstetric and gynecological scans and equipment cleaning in the context of COVID‐19. Ultrasound Obstet Gynecol Off J Int Soc Ultrasound Obstet Gynecol. 2020; published online March 23;55:709‐712. doi:10.1002/uog.22027 PubMed DOI

RCOG . Coronavirus (COVID‐19) Infection in Pregnancy. 2021. https://www.rcog.org.uk/globalassets/documents/guidelines/2021‐08‐25‐coronavirus‐covid‐19‐infection‐in‐pregnancy‐v14.pdf (accessed June 20, 2021).

Stampini V, Monzani A, Caristia S, et al. The perception of Italian pregnant women and new mothers about their psychological wellbeing, lifestyle, delivery, and neonatal management experience during the COVID‐19 pandemic lockdown: a web‐based survey. BMC Pregnancy Childbirth. 2021;21:473. PubMed PMC

Değirmenci F, Vefikuluçay YD. The relationship between psychosocial health status and social support of pregnant women. J Psychosom Obstet Gynecol. 2020;41:290‐297. PubMed

Wang D, Li Y‐L, Qiu D, Xiao S‐Y. Factors influencing paternal postpartum depression: a systematic review and meta‐analysis. J Affect Disord. 2021;293:51‐63. PubMed

Ceulemans M, Foulon V, Ngo E, et al. Mental health status of pregnant and breastfeeding women during the COVID‐19 pandemic—a multinational cross‐sectional study. Acta Obstet Gynecol Scand. 2020;151(1):146‐147. doi:10.1111/aogs.14092 PubMed DOI PMC

Ravaldi C, Wilson A, Ricca V, Homer C, Vannacci A. Pregnant women voice their concerns and birth expectations during the COVID‐19 pandemic in Italy. Women Birth. 2021;34:335‐343. PubMed PMC

Jacobson NC, Lekkas D, Price G, et al. Flattening the mental health curve: COVID‐19 stay‐at‐home orders are associated with alterations in mental health search behavior in the United States. JMIR Ment Health. 2020;7:e19347. PubMed PMC

Anxiety and depressive symptoms in pregnant women during the COVID-19 pandemic in the Czech Republic-Broader sociodemographic causes, connections and implications