Objective To assess risk factors for anxiety and depression among pregnant women during the COVID‐19 pandemic using Mind‐COVID, a prospective cross‐sectional study that compares outcomes in middle‐income economies and high‐income economies. Methods A total of 7102 pregnant women from 12 high‐income economies and nine middle‐income economies were included. The web‐based survey used two standardized instruments, General Anxiety Disorder‐7 (GAD‐7) and Patient Health Questionnaire–9 (PHQ‐9). Result Pregnant women in high‐income economies reported higher PHQ‐9 (0.18 standard deviation [SD], P < 0.001) and GAD‐7 (0.08 SD, P = 0.005) scores than those living in middle‐income economies. Multivariate regression analysis showed that increasing PHQ‐9 and GAD‐7 scales were associated with mental health problems during pregnancy and the need for psychiatric treatment before pregnancy. PHQ‐9 was associated with a feeling of burden related to restrictions in social distancing, and access to leisure activities. GAD‐7 scores were associated with a pregnancy‐related complication, fear of adverse outcomes in children related to COVID‐19, and feeling of burden related to finances. Conclusions According to this study, the imposed public health measures and hospital restrictions have left pregnant women more vulnerable during these difficult times. Adequate partner and family support during pregnancy and childbirth can be one of the most important protective factors against anxiety and depression, regardless of national economic status.

Introduction The burden of perinatal mental health problems was expected to increase during the COVID‐19 pandemic. We prospectively investigated the impact of the COVID‐19 pandemic on the mental health of pregnant and postpartum women in Norway and explored associations with their sociodemographic characteristics and personality traits. Material and methods Sociodemographic information and the self‐reported impact of pandemic on wellbeing of pregnant women was collected using an online survey. To assess women's mental health, two validated questionnaires, the Edinburgh Postpartum Depression Scale (EPDS) and the Generalized Anxiety Disorder‐7 item Scale (GAD‐7), were used prenatally and postnatally. Personality traits were evaluated using HumanGuide, a web‐based ipsative psychological evaluation instrument. Results 772 women were included prenatally, of which 526 also responded to the survey 4–6 weeks postnatally. The median age was 29 years, 53.6% of the women were nulliparous when enrolled, and 35.1% worked in the healthcare sector. The median EPDS (6.0; interquartile range [IQR] 3.0–10.0 vs 6.0; IQR: 3.0–10.0) and the median GAD‐7 (5.0; IQR 2.0–9.0 vs 5.0; IQR 2.0–9.0) were similar pre‐and postnatally. Prenatally, the proportion of women scoring ≥13 on EPDS and ≥10 on GAD‐7 was 14.5% (112/772) and 21.5% (166/772), whereas the postnatal figures were 15.6% (82/526) and 21.5% (113/526), respectively. The differences were not significant (P = 0.59 and P = 0.99). Being <25 years of age, being on pre‐pregnancy psychotherapy or psychotropic medication, frequent voluntary isolation, perception of maternity care not proceeding normally, avoiding seeking medical assistance due to fear of infection and having negative economic consequences during the COVID19 pandemic significantly increased the risk of both anxiety (GAD‐7 ≥10) and depression (EPDS ≥13). Nullipara had a higher risk of anxiety, whereas being a healthcare worker had a lower risk. The personality trait factors Power (P = 0.008), Quality (P = 0.008), Stability (P < 0.001) and Contacts (P < 0.001) were significant predictors of depression among pregnant women, whereas the Quality (P = 0.005) and Contacts (P = 0.003) were significant predictors of anxiety. Conclusions During the initial phase of the COVID‐19 pandemic, the prevalence of depression (EPDS ≥ 13) and anxiety (GAD‐7 ≥ 10) was 14.5% and 21.5%, respectively, among Norwegian pregnant women. Certain sociodemographic characteristics and personality traits were significant predictors of depression and anxiety.