The COVID-19 Pandemic Impacted Maternal Mental Health Differently Depending on Pregnancy Status and Trimester of Gestation

Abstract

Introduction: We aimed to measure the impact of the COVID-19 pandemic on maternal mental health, stratifying on pregnancy status, trimester of gestation, and pandemic period/wave. Methods: Pregnant persons and persons who delivered in Canada during the pandemic, >18 years, were recruited, and data were collected using a web-based strategy. The current analysis includes data on persons enrolled between 06/2020−08/2021. Maternal sociodemographic indicators, mental health measures (Edinburgh Perinatal Depression Scale (EPDS), Generalized Anxiety Disorders (GAD-7), stress) were self-reported. Maternal mental health in pregnant women (stratified by trimester, and pandemic period/wave at recruitment) was compared with the mental health of women who had delivered; determinants of severe depression were identified with multivariate logistic regression models. Results: 2574 persons were pregnant and 626 had already delivered at recruitment. Participants who had delivered had significantly higher mean depressive symptom scores compared to those pregnant at recruitment (9.1 (SD, 5.7) vs. 8.4 (SD, 5.3), p = 0.009). Maternal anxiety (aOR 1.51; 95%CI 1.44−1.59) and stress (aOR 1.35; 95%CI 1.24−1.48) were the most significant predictors of severe maternal depression (EDPS ˃ 13) in pregnancy. Conclusion: The COVID-19 pandemic had a significant impact on maternal depression during pregnancy and in the post-partum period. Given that gestational depression/anxiety/stress has been associated with preterm birth and childhood cognitive problems, it is essential to continue following women/children, and develop strategies to reduce COVID-19′s longer-term impact.

Keywords: COVID-19 pandemic; Edinburgh Perinatal Depression Scale (EPDS); Generalized Anxiety Disorders (GAD-7); maternal mental health; pregnancy and delivery; stress; trimester of pregnancy.

Figure 1

Study design and data collection.

Figure 2

Study flow chart.

Figure 3

Mean maternal depression scores using the Edinburgh Postnatal Depression Scale (EPDS) according to pregnancy status and trimester of pregnancy. Cohort 1 = women who delivered between 13 March and today at the time of recruitment; n = 498; missing values on maternal depression = 128. Cohort 2 = women who were pregnant at the time of the recruitment; n = 2251; missing values on maternal depression = 323. p-value between cohort 1 and 2 = 0.0091. 1st trimester = women who were at their 1st trimester of pregnancy at the time of recruitment; n = 411; missing values on maternal depression = 93. 2nd trimester = women who were at their 2nd trimester of pregnancy at the time of recruitment; n = 925; missing values on maternal depression = 107. 3rd trimester = women who were at their 3rd trimester of pregnancy at the time of recruitment; n = 915; missing values on maternal depression = 123. p-value for all trimesters = 0.0074.

Figure 4

(a) Prevalence of severe maternal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) cut-off (≥13) according to pregnancy status and trimester of pregnancy. Cohort 1 = women who delivered between 13 March and today at the time of recruitment; n = 498; missing values on maternal depression = 128. Cohort 2 = women who were pregnant at the time of the recruitment; n = 2251; missing values on maternal depression = 323. p-value between cohort 1 and 2 = 0.0627. 1st trimester = women who were at their 1st trimester of pregnancy at the time of recruitment; n = 411; missing values on maternal depression = 93. 2nd trimester = women who were at their 2nd trimester of pregnancy at the time of recruitment; n = 925; missing values on maternal depression = 107. 3rd trimester = women who were at their 3rd trimester of pregnancy at the time of recruitment; n = 915; missing values on maternal depression = 123. p-value for all trimesters = 0.0542. (b) Prevalence of moderate to severe maternal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) cut-off (>9) according to pregnancy status and trimester of pregnancy. Cohort 1 = women who delivered between 13 March and today at the time of recruitment; n = 498; missing values on maternal depression = 128. Cohort 2 = women who were pregnant at the time of the recruitment; n = 2251; missing values on maternal depression = 323. p-value between cohort 1 and 2 = 0.1185. 1st trimester = women who were at their 1st trimester of pregnancy at the time of recruitment; n = 411; missing values on maternal depression = 93. 2nd trimester = women who were at their 2nd trimester of pregnancy at the time of recruitment; n = 925; missing values on maternal depression = 107. 3rd trimester = women who were at their 3rd trimester of pregnancy at the time of recruitment; n = 915; missing values on maternal depression = 123. p-value for all trimesters = 0.0059 (Compared to the 1st trimester, women in their 3rd trimester had significant results).

Figure 5

Mean maternal anxiety score using the Generalized Anxiety Disorder 7-item scale (GAD-7) according to pregnancy status and trimester of pregnancy. Cohort 1 = women who delivered between 13 March and today at the time of recruitment; n = 489; missing values on maternal depression = 137. Cohort 2 = women who were pregnant at the time of the recruitment; n = 2220; missing values on maternal depression = 354. p-value between cohort 1 and 2 = 0.0139. 1st trimester = women who were at their 1st trimester of pregnancy at the time of recruitment; n = 403; missing values on maternal depression = 101. 2nd trimester = women who were at their 2nd trimester of pregnancy at the time of recruitment; n = 917; missing values on maternal depression = 115. 3rd trimester = women who were at their 3rd trimester of pregnancy at the time of recruitment; n = 900; missing values on maternal depression = 138. p-value for all trimesters = 0.4146.

Figure 6

(a) Prevalence of severe maternal anxiety symptoms using the Generalized Anxiety Disorder 7-item scale (GAD-7) cut-off (>15) according to pregnancy status and trimester of pregnancy. Cohort 1 = women who delivered between 13 March and today at the time of recruitment; n = 489; missing values on maternal depression = 137.Cohort 2 = women who were pregnant at the time of the recruitment; n = 2220; missing values on maternal depression = 354. p-value between cohort 1 and 2 = 0.1908. 1st trimester = women who were at their 1st trimester of pregnancy at the time of recruitment; n = 403; missing values on maternal depression = 101. 2nd trimester = women who were at their 2nd trimester of pregnancy at the time of recruitment; n = 917; missing values on maternal depression = 115. 3rd trimester = women who were at their 3rd trimester of pregnancy at the time of recruitment; n = 900; missing values on maternal depression = 138. p-value for all trimesters = 0.4808 (No significant results when compared 2nd trimester and 3rd trimester to 1st trimester). (b) Prevalence of moderate to severe maternal anxiety symptoms using the Generalized Anxiety Disorder 7-item scale (GAD-7) cut-off (>10) according to pregnancy status and trimester of pregnancy. Cohort 1 = women who delivered between 13 March and today at the time of recruitment; n = 489; missing values on maternal depression = 137. Cohort 2 = women who were pregnant at the time of the recruitment; n = 2220; missing values on maternal depression = 354.np-value between cohort 1 and 2 = 0.0479. 1st trimester = women who were at their 1st trimester of pregnancy at the time of recruitment; n = 403; missing values on maternal depression = 101. 2nd trimester = women who were at their 2nd trimester of pregnancy at the time of recruitment; n = 917; missing values on maternal depression = 115. 3rd trimester = women who were at their 3rd trimester of pregnancy at the time of recruitment; n = 900; missing values on maternal depression = 138. p-value for all trimesters = 0.4513 (No significant results when compared 2nd trimester and 3rd trimester to 1st trimester).

Figure 7

Mean maternal COVID-19-related stress using a scale from 1 (No stress) to 10 (Extreme stress) according to pregnancy status and trimester of pregnancy. Cohort 1 = women who delivered between 13 March and today at the time of recruitment; n = 527; missing values on maternal depression = 99. Cohort 2 = women who were pregnant at the time of the recruitment; n = 2314; missing values on maternal depression = 260. p-value between cohort 1 and 2 <0.0001. 1st trimester = women who were at their 1st trimester of pregnancy at the time of recruitment; n = 424; missing values on maternal depression = 80. 2nd trimester = women who were at their 2nd trimester of pregnancy at the time of recruitment; n = 948; missing values on maternal depression = 84. 3rd trimester = women who were at their 3rd trimester of pregnancy at the time of recruitment; n = 946; missing values on maternal depression = 96. p-value for all trimesters <0.0001.

Figure 8

Mean maternal depression scores using the Edinburgh Postnatal Depression Scale (EPDS) according to the recruitment period. 1st wave: recruitment between June and August 2020; n = 1605; missing values on maternal depression = 221. 2nd wave: recruitment from September 2020 to March 2021; n = 184; missing values on maternal depression = 32. 3rd wave: recruitment from April 2021 to August 2021; n = 462; missing values on maternal depression = 70. p-value < 0.0001.

Figure 9

Mean maternal anxiety score using the Generalized Anxiety Disorder 7-item scale (GAD-7) according to the recruitment period. 1st wave: recruitment between June and August 2020; n = 1577; missing values on maternal depression = 249. 2nd wave: recruitment from September 2020 to March 2021; n = 181; missing values on maternal depression = 35. 3rd wave: recruitment from April 2021 to August 2021; n = 462; missing values on maternal depression = 70. p-value < 0.0001.

Figure 10

Mean maternal COVID-19-related stress due to the COVID-19 pandemic using a scale from 1 (No stress) to 10 (extreme stress) according to the recruitment period. 1st wave: recruitment between June and August 2020; n = 1653; missing values on maternal depression = 173. 2nd wave: recruitment from September 2020 to March 2021; n = 188; missing values on maternal depression = 28. 3rd wave: recruitment from April 2021 to August 2021; n = 473; missing values on maternal depression = 59. p-value < 0.0001.