INTRODUCTION: Prenatal mental health problems are associated with morbidity for the pregnant person, and their infants are at long-term risk for poor health outcomes. We aim to explore how the SARS-CoV-2 pandemic affected the mental health of pregnant people in the United Kingdom (UK), and to further identify resilience factors which may have contributed to varying mental health outcomes. We also aim to examine the quality of antenatal care provided during the pandemic in the UK and to identify potential inadequacies to enhance preparedness for future events. METHODS: During June-November 2020, we recruited 3666 individuals in the UK for the EPPOCH pregnancy cohort (Maternal mental health during the COVID-19 pandemic: Effect of the Pandemic on Pregnancy Outcomes and Childhood Health). Participants were assessed for depression, anxiety, anger and pregnancy-related anxiety using validated scales. Additionally, physical activity, social support, individualized support and personal coping ability of the respondents were assessed as potential resilience factors. RESULTS: Participants reported high levels of depression (57.05%), anxiety (58.04%) and anger (58.05%). Higher levels of social and individualized support and personal coping ability were associated with lower mental health challenges. Additionally, pregnant individuals in the UK experienced higher depression during the pandemic than that reported in Canada. Finally, qualitative analysis revealed that restrictions for partners and support persons during medical appointments as well as poor public health communication led to increased mental health adversities and hindered ability to make medical decisions. DISCUSSION: This study revealed increased mental health challenges among pregnant individuals in the UK during the SARS-CoV-2 pandemic. These results highlight the need for reassessing the mental health support measures available to pregnant people in the UK, both during times of crisis and in general.

Alberta Children's Hospital Research Institute University of Calgary Calgary AB Canada

Centre for Midwifery and Women's Health Bournemouth University Bournemouth United Kingdom

Department of Community Health Sciences University of Calgary Calgary AB Canada

Department of Family Medicine University of British Columbia Vancouver BC Canada

Department of Pediatrics University of Calgary Calgary AB Canada

Department of Psychology University of Calgary Calgary AB Canada

Department of Psychosomatic Medicine and Psychotherapy Charité Universitätsmedizin Berlin Berlin Germany

Department of Radiology University of Calgary Calgary AB Canada

Faculty of Environment Julius von Payer Institute for Arctic and Subarctic Research Jan Evangelista Purkyně University Ústí nad Labem Czechia

Institute for Medical Psychology Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt Universität zu Berlin Berlin Institute of Health Berlin Germany

Institute of Botany and Landscape Ecology University of Greifswald Greifswald Germany

Institute of Microbiology Infectious Diseases and Immunology Charité Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt Universität zu Berlin Berlin Institute of Health Berlin Germany

Neonatology and Pediatric Intensive Care Faculty of Medicine University of Augsburg Augsburg Germany

Psychoneuroimmunology Laboratory Department of Psychosomatic Medicine and Psychotherapy Justus Liebig University Gießen Germany

University Hospitals Dorset NHS Foundation Trust Poole United Kingdom

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