Pregnant under the pressure of a pandemic: a large-scale longitudinal survey before and during the COVID-19 outbreak

Abstract

Background: One of the groups that is most vulnerable to the COVID-19 pandemic is pregnant women. They cannot choose to refrain from care; they and their children are at risk of severe complications related to the virus; and they lose comfort and support as clinics prohibit their partners and as societal restrictions demand isolation from friends and relatives. It is urgent to study how this group is faring during the pandemic and we focus here on their health-related worries.

Methods: A longitudinal survey at a Swedish hospital starting 6 months before (16 September 2019) and continuing during the COVID-19 outbreak (until 25 August 2020). A total of 6941 pregnant women and partners of diverse social backgrounds were recruited. Ninety-six percent of birth-giving women in the city take early ultrasounds where recruitment took place. Sixty-two percent of the women with an appointment and fifty-one percent of all partners gave consent to participate.

Results: Pregnant women experienced dramatically increased worries for their own health, as well as for their partner's and their child's health in the beginning of the pandemic. The worries remained at higher than usual levels throughout the pandemic. Similar, but less dramatic changes were seen among partners.

Conclusions: There is a need for heightened awareness of pregnant women's and partners' health-related worries as a consequence of the COVID-19 pandemic. Related feelings, such as anxiety, have been linked to adverse pregnancy outcome and might have long-term effects. The healthcare system needs to prepare for follow-up visits with these families.

Figure 1

Mentions of ‘COVID’, ‘corona’ and related keywords in the Swedish Pregnancy Panel during late 2019 and first half of 2020. Notes: The proportion is calculated based on the total number of answers in the different questionnaires. The base of the calculation is thus the number of answers that potentially could include COVID-19-related answers on 1 single day, here illustrated using a 3-week moving average of the observed percentage of survey responses that mentioned at least one of the keywords ‘COVID’, ‘corona’, ‘SARS’, ‘pandemic’ or ‘virus’ for any of the open-ended questions in any of the active surveys. The average proportion among pregnant women before 12 March was 1.6% (n = 6893) and post was 35.7% (n = 2498). The corresponding numbers for partners are 0.6% (n = 6562) and 26.0% (n = 1625). Among the 12 open answer questions were questions about important societal issues, feelings evoked by pregnancy, what the respondents discuss with friends, and general comments at the end of the survey.

Figure 2

Ways in which respondents are personally affected by the coronavirus and its consequences. Notes: Unweighted estimates. Answers given between 24 March and 25 August, 2020. Pooled N, pregnant woman = 4576; partner = 2080 (individual n, pregnant woman = 1723, partner = 1016). Question wording: ‘In what way are you personally affected by the coronavirus and its consequences?’ Examples of codes used for the reported categories: Work and personal economy: Changed workload, Lost savings, I lost my job. Social isolation: Have chosen/been forced to isolate myself completely or partly, Do not see friends, Grandparents not allowed to meet the newborn baby. Pregnancy and childbirth: Worry about the childbirth, Worry about deficiencies in healthcare, Worry about the foetus’/newborn’s health, Partner cannot be present at the time of childbirth. Everyday life: Public transportations, Acting according to authorities’ advices, Helping others with purchases etc, Cancelled events, activities and trips. Society: Media reporting, Critical towards how society deals with the crisis, The impact on the economy on the societal level.

Figure 3

Worry about one’s own health (a), the child’s health, and (c) the partner’s health. Notes: Weighted estimates of a normalized dependent variable (ranging 0–1). Pooled n, (a) = 7701 (4410 individuals); (b) = 7304 (4293 individuals); (c) = 7800 (4373 individuals). Question wording: ‘How worried are you currently about the following?’; eight response alternatives: 1 ‘Not at all worried’ to 7 ‘Very worried’, and 8 ‘Not applicable’. The opt-out alternative was not included in the analysis (0.2%, 5.0% and 1.0%, respectively, of the overall responses for the three items reported).

Figure 4

Respondents’ pre- and post-12 March worry for their own health by subgroup. Notes: The visualized means are the pooled unweighted worry levels before and after 12 March (normalized to range from 0 to 1). 95% CIs are shown for each parameter. The vertical line displays the pooled means of the entire period for pregnant women (0.36) and partners (0.30), respectively. Education is divided into four categories, recoded from a nine-category question: Low education = up to ‘Upper secondary school’, mid-level education = up to ‘University/college education, shorter than 3 years’, high education = ‘University/college education, longer than 3 years’, very high education = ‘PhD’. Low income = up to 25 999 SEK/month (∼2800 USD), mid-level income: 26 000–44 999, high income: 45 000+. Healthcare trust question wording: ‘In general, how much confidence do you have in the following institutions and actors in Sweden?—Healthcare system’; Low trust = 1 ‘Very Little’ and 2 ‘Not much’, mid-level trust = 3 ‘Neither a lot nor a little’, high trust = 4 ‘Quite a lot’ and 5 ‘A lot’. Be with friends, question wording: ‘In the last three months, how often have you done the following: Spent time with friends’: Sometime during the last 3 months, About once a month, Several times a month, About once a week, Several times a week, Every day.