Prenatal anxiety and obstetric decisions among pregnant women in Wuhan and Chongqing during the COVID‐19 outbreak: a cross‐sectional study

Abstract

Objectives To investigate the mental status of pregnant women and to determine their obstetric decisions during the COVID‐19 outbreak. Design Cross‐sectional study. Setting Two cities in China––Wuhan (epicentre) and Chongqing (a less affected city). Population A total of 1947 pregnant women. Methods We collected demographic, pregnancy and epidemic information from our pregnant subjects, along with their attitudes towards COVID‐19 (using a self‐constructed five‐point scale). The Self‐Rating Anxiety Scale (SAS) was used to assess anxiety status. Obstetric decision‐making was also evaluated. The differences between cities in all of the above factors were compared and the factors that influenced anxiety levels were identified by multivariable analysis. Main outcome measures Anxiety status and its influencing factors. Obstetric decision‐making. Results Differences were observed between cities in some background characteristics and women's attitudes towards COVID‐19 in Wuhan were more extreme. More women in Wuhan felt anxious (24.5 versus 10.4%). Factors that influenced anxiety also included household income, subjective symptom and attitudes. Overall, obstetric decisions also revealed city‐based differences; these decisions mainly concerned hospital preference, time of prenatal care or delivery, mode of delivery and infant feeding. Conclusions The outbreak aggravated prenatal anxiety and the associated factors could be targets for psychological care. In parallel, key obstetric decision‐making changed, emphasising the need for pertinent professional advice. Special support is essential for pregnant mothers during epidemics. Tweetable abstract The COVID‐19 outbreak increased pregnant women's anxiety and affected their decision‐making.

Motherhood in the Time of Coronavirus: The Impact of the Pandemic Emergency on Expectant and Postpartum Women’s Psychological Well-Being

“…Most of the studies published in the last months on the effect of the Covid-19 pandemic on pregnancy and childbirth have mainly focused on medical conditions and risk factors and have attempted to pinpoint the measures and clinical recommendations required to contain the Covid-19 spread (e.g., Chen et al, 2020;Liang and Acharya, 2020). The scant literature that has addressed the psychological impact of the Covid-19 pandemic on expectant and postpartum women has found higher levels of anxiety and depressive symptoms among participants when compared to similar cohorts assessed before the outbreak (Ceulemans et al, 2020;Lebel et al, 2020;Liu et al, 2020;Patabendige et al, 2020). An Italian study investigating the psychological effects of the pandemic on pregnant women found a significant change in their expectations toward pregnancy and childbirth as well as an increase in their concerns and distress, especially if they had a previous history of psychological distress in press (Ravaldi et al, 2020).…”

Pregnant Women’s Health-related Behavior Changes and Psychological Status After the Peak of COVID-19 Outbreak in China: A Cross-sectional Study

“…Earlier studies reported that pregnant women from different countries experienced different levels of anxiety or depression during the early or peak period of COVID-19 [5][6][7][8]12]. In Wuhan, 24.5% of pregnant women reported self-rated anxiety, compared with 10.4% of that in Chongqing, China [6].…”

“…The rate of anxiety (assessed by state-trait anxiety inventory) was 38.2% among pregnant women in Italy [8]. The rate of depression (assessed by EPDS) was 35.4% among Turkish pregnant women and 29.6% among Chinese women in the third trimester of pregnancy [5,7]. Although the peak of the epidemic in China has passed, the psychological condition of pregnant women does not seem to improve, as we found that 73 (64.6%), 66 (58.4%) and 62 (54.9%) pregnant women had anxiety, depression and health risk stress,…”

“…Preventing a rebound and preventing imports from abroad are essential. During the initial stage or peak of the COVID-19 outbreak, studies from China [5,6], Turkey [7], Italy [8], Canada [9], and Israel [10] have found that the COVID-19 had adverse psychological impact on women during pregnancy, such as increasing anxiety and depression symptoms. Several studies reported the behavior responses of pregnant women during the COVID-19 epidemic, such as wearing masks, washing hands more frequently and stocking up behaviors [11][12][13].…”

Re: Maternal transmission of SARS‐COV‐2 to the neonate, and possible routes for such transmission: a systematic review and critical analysis

“…However, the severity of the COVID‐19 infection of the mothers was not considered. Clinically, pregnant women with the more severe COVID‐19 infection appear to prefer delivery by caesarean delivery rather than vaginal birth 2–4 . Therefore, it is possible that any beneficial effects of caesarean birth in reducing transmission of COVID‐19 might not be apparent because the severity of COVID‐19 infection was greater in these women.…”