Perinatal depressive and anxiety symptoms of pregnant women during the coronavirus disease 2019 outbreak in China

Abstract

Background: On January 20, 2020, a new coronavirus epidemic with human-to-human transmission was officially declared by the Chinese government, which caused significant public panic in China. In light of the coronavirus disease 2019 outbreak, pregnant women may be particularly vulnerable and in special need for preventive mental health strategies. Thus far, no reports exist to investigate the mental health response of pregnant women to the coronavirus disease 2019 outbreak.

Objective: This study aimed to examine the impact of coronavirus disease 2019 outbreak on the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women across China.

Study design: A multicenter, cross-sectional study was initiated in early December 2019 to identify mental health concerns in pregnancy using the Edinburgh Postnatal Depression Scale. This study provided a unique opportunity to compare the mental status of pregnant women before and after the declaration of the coronavirus disease 2019 epidemic. A total of 4124 pregnant women during their third trimester from 25 hospitals in 10 provinces across China were examined in this cross-sectional study from January 1, 2020, to February 9, 2020. Of these women, 1285 were assessed after January 20, 2020, when the coronavirus epidemic was publicly declared and 2839 were assessed before this pivotal time point. The internationally recommended Edinburgh Postnatal Depression Scale was used to assess maternal depression and anxiety symptoms. Prevalence rates and risk factors were compared between the pre- and poststudy groups.

Results: Pregnant women assessed after the declaration of coronavirus disease 2019 epidemic had significantly higher rates of depressive symptoms (26.0% vs 29.6%, P=.02) than women assessed before the epidemic declaration. These women were also more likely to have thoughts of self-harm (P=.005). The depressive rates were positively associated with the number of newly confirmed cases of coronavirus disease 2019 (P=.003), suspected infections (P=.004), and deaths per day (P=.001). Pregnant women who were underweight before pregnancy, primiparous, younger than 35 years, employed full time, in middle income category, and had appropriate living space were at increased risk for developing depressive and anxiety symptoms during the outbreak.

Conclusion: Major life-threatening public health events such as the coronavirus disease 2019 outbreak may increase the risk for mental illness among pregnant women, including thoughts of self-harm. Strategies targeting maternal stress and isolation such as effective risk communication and the provision of psychological first aid may be particularly useful to prevent negative outcomes for women and their fetuses.

Keywords: COVID-19; Edinburgh Postnatal Depression Scale; perinatal anxiety; perinatal depression.

Figure 1

The COVID-19 epidemic characteristics, prevalence of perinatal depression, and association between perinatal depression and daily cases change of COVID-19 infection A, The increased number of COVID-19 infection confirmed cases and suspected cases. B, The prevalence of perinatal depression change. C–E, Association between confirmed COVID-19, suspected, or death cases and perinatal depression prevalence as predicted prevalence and 95% confidence interval in the whole population. Analyses were adjusted for potential confounders such as age, body mass index, education levels, occupation, annual household income, parity, investigation sites, family support, per capita living area, maternal only-child status, pregnancy complication, and exercise. COVID-19, coronavirus disease 2019; EPDS, Edinburgh Postnatal Depression Scale. Wu et al. Depressive and anxiety symptoms in pregnancy during COVID-19 outbreak. Am J Obstet Gynecol 2020.

Figure 2

Prevalence of perinatal depression and attributable risk proportion in subgroups A, The prevalence of PND before and after the COVID-19 epidemic declaration Filled circles signify significance in which P<.05. BMI, <18.5 kg/m²; age, <35 years; parity, primiparous; per capita living area, ≥20 m²; annual household income, middle ($10,001–$40,000); occupation, full-time worker; exercise, <7 hours per week. B, ARP and 95% CI of COVID-19 epidemic declaration in subgroups. ARP, attributable risk proportion; BMI, body mass index; CI, confidence interval; COVID-19, coronavirus disease 2019; PND, perinatal depression. Wu et al. Depressive and anxiety symptoms in pregnancy during COVID-19 outbreak. Am J Obstet Gynecol 2020.