Pandemics and maternal health: the indirect effects of COVID‐19

Abstract

Summary Infectious diseases can directly affect women and men differently. During the COVID‐19 pandemic, higher case fatality rates have been observed in men in most countries. There is growing evidence, however, that while organisational changes to healthcare delivery have occurred to protect those vulnerable to the virus (staff and patients), these may lead to indirect, potentially harmful consequences, particularly to vulnerable groups including pregnant women. These encompass reduced access to antenatal and postnatal care, with a lack of in‐person clinics impacting the ability to screen for physical, psychological and social issues such as elevated blood pressure, mental health issues and sex‐based violence. Indirect consequences also encompass a lack of equity when considering the inclusion of pregnant women in COVID‐19 research and their absence from vaccine trials, leading to a lack of safety data for breastfeeding and pregnant women. The risk‐benefit analysis of these changes to healthcare delivery remains to be fully evaluated, but the battle against COVID‐19 cannot come at the expense of losing existing quality standards in other areas of healthcare, especially for maternal health.

Molecular and Physiological Aspects of SARS-CoV-2 Infection in Women and Pregnancy

“…Psychological stress is a known risk factor for miscarriage, especially during early pregnancy, which might be linked to elevated cortisol levels ( 279 , 280 ). Furthermore, the pandemic lead to hampered access to pre- and postnatal care services, possibly contributing to underdiagnosis of complications ( 281 ). Interestingly, pregnant women were found to be at lower risk for depressive symptoms in comparison to non-pregnant women and mothers delivering during the COVID-19 pandemic had reduced risk of postpartum-depression than before the pandemic ( 282 , 283 ).…”

The level of depression, anxiety, and sleep quality in pregnancy during coronavirus disease 2019 pandemic

“…12 The occurrence of stress, fear, and anxiety at higher levels than expected creates more emphasis on potential maternal, fetal, and psychiatric complications in pregnant women. [14][15][16] No studies are available in the literature investigating the trimesters of pregnancy by their coincidence with the pandemic, examining the severity of maternal mental health disorders that might have caused by the pandemic, and investigating especially the effects of the pandemic on sleep quality. Therefore, in this study, we aimed to evaluate the level of depression and anxiety symptoms and sleep quality of pregnant women in different trimesters during COVID-19 pandemic and to investigate the effects of quarantine and lifestyle changes that come into our lives with pandemic.…”

“…Changes in routine work schedules in hospitals due to the pandemic and concerns on the potential of pregnant women to get infection have led to deficiencies in the pregnancy prenatal visits 12 . The occurrence of stress, fear, and anxiety at higher levels than expected creates more emphasis on potential maternal, fetal, and psychiatric complications in pregnant women 14–16 …”

Pregnancy during the COVID‐19 pandemic: A cross‐sectional observational descriptive study

“…These levels of fear could have repercussions in terms of complications such as premature birth, low birthweight or intrauterine growth restriction. Fear could be reduced by ensuring the continuity of prenatal education, guidance during pregnancy, and follow‐up of pregnant women by telephone (Chen et al., 2020 ; Coşkuner Potur et al., 2017 ; Lucas & Bamber, 2021 ). Understanding the fears and emotional states of pregnant women could aid in the implementation of effective mental health prevention measures, particularly during infectious disease epidemics.…”