The effects of COVID-19 on stress, depression, and anxiety in pregnant and postpartum women

A recent study published in the journal Midwifery evaluated depression, stress, and anxiety in pregnant and postpartum individuals during the coronavirus disease 2019 (COVID-19) pandemic.

Study: Depression, Anxiety, and Stress in Pregnancy and Postpartum: A Longitudinal Study During the COVID-19 Pandemic. Image Credit: Mr.Thunman / Shutterstock

Background

Poor mental health symptoms during pregnancy are associated with a higher risk of birth complications, pre-eclampsia, and preterm birth. Evidence shows that perinatal psychopathology is linked to poor cognitive, language, motor, and social/emotional development.

Further, the COVID-19 pandemic might have sharply increased psychopathology rates in pregnant and postpartum individuals. Many factors may influence symptom trajectories for pregnant/postpartum individuals during the pandemic, aggravating existing mental health conditions or triggering new-onset stress, depression, or anxiety.

About the study

In the current study, researchers longitudinally evaluated pregnant and postpartum individuals for stress, depression, and anxiety during the COVID-19 pandemic. Advertisements were posted inviting pregnant individuals in the United States (US) to complete online surveys between June 15, 2020, and January 16, 2021.

Eligible subjects were pregnant individuals and those who gave birth in the last month. Participants were eligible for up to three surveys. Demographic data, such as age, parity, marital status, smoking status, alcohol use, and race, were collected. Participants self-reported the current week of pregnancy, due date, and date of birth/delivery.

The team used the 21-item depression, anxiety, and stress scale to assess stress levels and anxiety symptoms and the 10-item Edinburgh postnatal depression scale (EPDS) to evaluate depression. They removed the item on suicidal ideation from the EPDS. The 12-item multidimensional scale of perceived social support was used to examine social support. Participants were queried about COVID-19 restrictions and their perceived impact on life.

The first hypothesis was that depression, stress, and anxiety levels would remain consistently elevated over time. Second, the team hypothesized that symptoms would follow a curvilinear trajectory increasing from early to later pregnancy and decreasing in the postpartum period and that findings would be significant after accounting for COVID-19-related and sociodemographic factors.

Further, they speculated that COVID-19 would lead to low social support, higher levels of worry about accessing healthcare, high-risk pregnancy status, high levels of perceived changes in the routine, maternal age, and parity would lead to higher levels of stress, anxiety, and depression at one month postpartum.

Findings

Overall, 150 individuals provided sufficient data at baseline for study outcomes. Of these, 17 gave birth in the past month, and seven failed to provide an email address, thus, leaving 126 pregnant individuals for follow-up surveys. 24 participants completed the survey at three points, 45 completed it twice, and 69 completed only the baseline survey.

Participants were in the 19-40 age group, mainly from the Midwest or Southern US. Most subjects were White (81%) and married (73%). Around 31% of participants were deemed high-risk pregnancies, while 52% were primiparous.

The authors observed a significant reduction in depressive symptoms and anxiety from the third trimester at one month postpartum, although stress levels were consistently elevated over time.

A quadratic trajectory best explained the change in symptoms. Depressive and anxiety symptoms increased until gestational weeks 23 to 25 and decreased afterward. However, stress levels remained consistently elevated. Lower social support and younger age significantly predicted elevated stress, anxiety, and depression at one month postpartum.

Higher worry about visiting a healthcare facility due to COVID-19 significantly predicted anxiety, depression, and stress at one month postpartum. COVID-19-induced changes in the routine, pregnancy risk, and parity did not predict symptoms.

Conclusions

The study demonstrated that anxiety and depression increased in early pregnancy before declining from weeks 23 and 25, respectively. Nevertheless, despite the reduction in symptoms overall, more than 30% of participants reported moderate anxiety, and 19% had moderate depressive symptoms at one month postpartum. Further, the symptom decline was relatively small to translate into a clinically significant change. Contrastingly, stress remained consistently elevated at all time points.

Notably, the team did not evaluate ethnicity/race as predictors for perinatal psychopathology, limiting the generalizability of the findings. The authors removed the suicide item from the 10-item EPDS, which may limit the reliability/validity of this scale.

Overall, healthcare providers and policymakers should focus on improving the mental health of obstetric patients by implementing regular screening, increasing social support, and promoting online interventions.