Pregnant and postpartum women at elevated risk of mental health problems during COVID-19 pandemic

Reviewed by Emily Henderson, B.Sc.Apr 22 2021

Substantial proportions of pregnant and postpartum women scored high for symptoms of anxiety, depression, loneliness and post-traumatic stress in relation to COVID-19 in a survey carried out in May and June 2020, according to a new study published this week in the open-access journal PLOS ONE by Karestan Koenen and Archana Basu of Harvard T.H. Chan School of Public Health, US, and colleagues.

Pregnant and postpartum women face unique challenges during the COVID-19 pandemic that may put them at elevated risk of mental health problems. These include concerns about greater severity of COVID-19 disease, potential infection of newborns and increased risk of adverse neonatal outcomes. Perinatal mental health problems are a critical public health issue which can adversely impact not only women's own health but also infant outcomes, mother-infant bonding, and later offspring health.

In the new study, researchers carried out an anonymous, online, cross-sectional survey of pregnant and postpartum women in 64 countries between May 26, 2020 and June 13, 2020. The survey was available in twelve languages and was advertised in social media and online parenting forums. Participants gave information on demographics, COVID-19 exposure and worries, information seeking behavior, COVID-19 prevention behaviors, and mental health symptoms. The mental health symptoms reported in the study were based on modified screening questionnaires rather than a clinical diagnosis.

The study found that, of 6,894 participants, a substantial number scored at or above the cut-off for elevated anxiety/depression (2,138, or 31 percent), loneliness (3,691, or 53 percent), and post-traumatic stress in relation to COVID-19 (2,979, or 43 percent), despite the fact that only 117 women (2 percent) had been diagnosed with COVID-19 and only 510 (7 percent) had been in contact with someone with COVID-19. These numbers were higher than rates of post-traumatic stress, anxiety and depression previously reported for the general population during the pandemic, or for perinatal and postpartum women prior to the COVID-19 pandemic.

Information seeking from any source--including social media, news or word-of-mouth--five or more times a day was associated with more than twice the odds of elevated post-traumatic stress in relation to COVID-19 and anxiety/depression. For example, checking social media more than five times a day was associated with 2.25 times higher odds of elevated post-traumatic stress (95%CI 1.92-2.65) and 2.83 times higher odds of anxiety/depression (95%CI 2.39-3.34). In addition, being very worried about COVID-19 was strongly associated with elevated post-traumatic stress (OR 4.75, 95%CI 3.34-6.87) and anxiety/depression (OR 1.51, 95% CI 1.09-2.13).

The majority of participants reported engaging in COVID-19 prevention behaviors (e.g., 93.3 percent reported practicing hand hygiene and 84.5 percent reported wearing a face mask) but these behaviors were not associated with anxiety/ depression symptoms. The authors suggest that COVID-19 prevention behaviors are central to containing the viral spread and mitigating physical health risk, but public health campaigns and medical care systems also need to explicitly address the impact of COVID-19 related stressors on mental health in perinatal women.

The authors add: "Our results suggest that globally, pregnant women and new moms' mental health is still another casualty of the COVID-19 pandemic. Maternal mental health and wellbeing is critical for mothers and foundational for healthy child development. There is an urgent need for maternal mental health to be fully integrated into standard prenatal and postpartum care."