Survey reveals elevated mental health problems among pregnant/postpartum women during COVID-19 pandemic

Reviewed by Emily Henderson, B.Sc.Apr 21 2021

In a worldwide survey, pregnant and postpartum women reported high levels of depression, anxiety, loneliness, and post-traumatic stress during the COVID-19 pandemic, according to researchers at Harvard T.H. Chan School of Public Health. Such high levels of distress may have potential implications for women and for fetal and child health and development, according to the study.

The study will be published online in PLOS ONE on April 21, 2021.

We expected to see an increase in the proportion of pregnant and postpartum women reporting mental health distress, as they are likely to be worried or have questions about their babies' health and development, in addition to their own or their family's health. However, the number of women who had significantly elevated symptoms was much larger than what had previously been published during the pandemic."

Karestan Koenen, study senior author, professor of psychiatric epidemiology at Harvard Chan School

Koenen and her co-authors were interested in pregnant and postpartum women because prior research suggests that perinatal mental health problems can adversely impact not only women's own health but also infant outcomes, mother-infant bonding, and children's health over time. To gauge the mental health of pregnant and postpartum women during the pandemic, the researchers conducted an anonymous, online, cross-sectional survey of women in 64 countries between May 26, 2020 and June 13, 2020. The survey, available in 12 languages, was hosted on the Pregistry platform for COVID-19 studies.

Of the 6,894 participants, substantial proportions of women scored at or above the cutoffs in widely-used psychological screening tools for elevated levels of anxiety/depression (31%), loneliness (53%), and post-traumatic stress in relation to COVID-19 (43%), despite the fact that only 117 women (2%) had been diagnosed with COVID-19 and 510 (7%) had been in contact with someone with COVID-19. The levels of psychiatric distress were significantly higher than previously published data on such distress in the general population during the pandemic and among pregnant and postpartum women before the pandemic.

Certain factors were linked with worse mental health among the women surveyed. Seeking information about the pandemic five or more times a day from any source (e.g., social media, news, or word-of-mouth) was associated with more than twice the odds of elevated post-traumatic stress in relation to COVID-19 and anxiety/depression. Worries about children and childcare and economic worries were also important factors in women's mental health.

The majority of participants reported engaging in COVID-19 prevention behaviors (e.g., 93.3% reported practicing hand hygiene and 84.5% reported wearing a face mask) but these behaviors were not associated with anxiety or depression symptoms.

First author Archana Basu, research scientist of the Department of Epidemiology, said that the study's results indicate that public health campaigns and medical care systems should explicitly address the impact of COVID-19-related stressors on mental health in pregnant and postpartum women.

"In addition to screening and monitoring mental health symptoms, addressing potentially modifiable factors such as excessive information seeking and women's worries about access to medical care and their children's well-being, and developing strategies to target loneliness, such as online support groups, should be part of intervention efforts for perinatal women," Basu said.