Common model of stress, anxiety, and depressive symptoms in pregnant women from seven high-income Western countries at the COVID-19 pandemic onset.

OBJECTIVE: Increases in stress, anxiety, and depression among women pregnant during the COVID-19 pandemic have been reported internationally. Yet rigorous comparison of the prevalence of maternal mental health problems across countries is lacking. Moreover, whether stress is a common predictor of maternal mental health during the pandemic across countries is unknown. METHODS: 8148 pregnant women from Germany, Israel, Italy, Poland, Spain, Switzerland, and the United States were enrolled in the International COVID-19 Pregnancy Experiences (I-COPE) Study between April 17 and May 31, 2020. Sociodemographic characteristics, pandemic-related stress, pregnancy-specific stress, anxiety, and depression were assessed with well-validated instruments. The magnitude of stress and mood disturbances was compared across countries. A path model predicting clinically significant levels of anxiety and depression from maternal characteristics and stress was tested for all study participants and then examined separately in each country with >200 participants. RESULTS: Countries differed significantly in magnitude of pandemic-related pregnancy stress and pandemic-unrelated pregnancy-specific stress, and in prevalence of clinically significant anxiety and depression levels. A well-fitting common path model for the entire sample indicated that mood and anxiety disturbances were strongly predicted by pandemic-related and pregnancy-specific stress after accounting for maternal characteristics. The model was replicated in individual countries. CONCLUSIONS: Although pregnant women in high-income Western countries experienced different levels of stress resulting from the COVID-19 pandemic, stress is a strong, common predictor of anxiety and depressive symptoms in these individuals. The common model can be used to inform research and clinical interventions to protect against adverse consequences of prenatal maternal stress, anxiety, and depression for mothers and infants.

Intrauterine fetal death in a COVID positive pregnant woman: a case report and literature review.

SARS-CoV-2 disease mechanisms are not yet fully understood, especially in cases affecting pregnant women. In fact, although they suffer from the same symptoms as non-pregnant women, they are more susceptible to adverse outcomes of COVID-19 as well as pregnancy complications leading to stillbirth, premature rupture of membrane, or intrauterine fetal demise (IUFD). The consequences on pregnancy are not clearly correlated with the severity of the infection. We present a case of fetal death in a 30-year-old woman with a confirmed SARS-CoV-2 infection without any other significant clinical or obstetric disorders. A histopathological examination of the placenta indicated massive and diffuse intervillar fibrinoid deposits associated with chronic histiocytic intervillositis that can be associated with SARS-CoV-2 placentitis. Given the high rates of SARS-CoV-2 infections in pregnancy, it is important to understand the factors that determine negative pregnancy outcomes, regardless of the severity of the patient's symptoms.

Stress, Coping, and Psychiatric Symptoms in Pregnant Women in Outpatient Care During the 2021 Second-Wave COVID-19 Pandemic.

Aims: Women face many sources of stress throughout their lives, and some periods are particularly sensitive; pregnancy is one of them. The COVID-19 pandemic is a likely source of additional stress for pregnant women. Moreover, there is evidence that pregnant women have experienced high levels of anxiety and depression symptoms during the pandemic. Our study aimed to evaluate the association of pregnancy-specific stress, pandemic-related stress, and coping strategies with anxiety, depressive and obsessive-compulsive symptomatology in Italian women during the second wave of the COVID-19 pandemic (December 2020-June 2021). We also investigated whether there were differences in these levels of psychopathology compared to a prior study conducted during the first pandemic wave (April-August 2020) in Italian pregnant women. Methods: We assessed 325 pregnant women receiving outpatient prenatal care, using the Revised Prenatal Distress Questionnaire (NuPDQ), Pandemic-Related Pregnancy Stress Scale (PREPS), the Revised Prenatal Coping Inventory (NuPCI), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2), and Obsessive-Compulsive Disorder (OCD) screening. The main analysis was conducted comparing multiple logistic regression models predicting each psychopathological outcome from specific covariates and NuPDQ, PREPS, and NuPCI scores. Results: 42.8% of the sample reported significant levels of anxiety, while 10.3% was positive on depression screening and 13.1% on OCD screening. No significant difference was found in the prevalence of high anxiety, depression, or OCD screening scores compared with the first pandemic wave. Controlling for covariates, we found that GAD-7 and PHQ-2 scores were predicted by pregnancy-specific stress; positive OCD screening was not. The model of high anxiety was improved by adding pandemic-related stress as a predictor (in particular, feeling unprepared for delivery and postpartum). Finally, coping strategies (avoidance, spiritual coping, and planning-preparation) significantly improved prediction of all three psychopathological outcomes. Conclusions: The present study suggests the importance of pregnancy-related stress, COVID-19 pandemic stress, and of coping strategies in counteracting or contributing to psychiatric symptomatology during the current pandemic.

Lung Ultrasound Signs and Their Correlation With Clinical Symptoms in COVID-19 Pregnant Women: The "PINK-CO" Observational Study.

OBJECTIVE: To analyze the application of lung ultrasound (LUS) diagnostic approach in obstetric patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and compare LUS score and symptoms of the patients. DESIGN: A single-center observational retrospective study from October 31, 2020 to March 31, 2021. SETTING: Department of Ob/Gyn at the University-Hospital of Udine, Italy. PARTICIPANTS: Pregnant women with SARS-CoV-2 diagnosed with reverse transcription-PCR (RT-PCR) swab test were subdivided as symptomatic and asymptomatic patients with COVID-19. EXPOSURE: Lung ultrasound evaluation both through initial evaluation upon admission and through serial evaluations. MAIN OUTCOME: Reporting LUS findings and LUS score characteristics. RESULTS: Symptomatic patients with COVID-19 showed a higher LUS (median 3.5 vs. 0, p < 0.001). LUS was significantly correlated with COVID-19 biomarkers as C-reactive protein (CPR; p = 0.011), interleukin-6 (p = 0.013), and pro-adrenomedullin (p = 0.02), and inversely related to arterial oxygen saturation (p = 0.004). The most frequent ultrasound findings were focal B lines (14 vs. 2) and the light beam (9 vs. 0). CONCLUSION: Lung ultrasound can help to manage pregnant women with SARS-CoV-2 infection during a pandemic surge. STUDY REGISTRATION: ClinicalTrials.gov, NCT04823234. Registered on March 29, 2021.

Psychometric properties of the Italian version of the Pandemic-Related Pregnancy Stress Scale (PREPS) and its correlation with anxiety and depression.

BACKGROUND: In the beginning of 2020, Italy was the first European country to face the COVID-19 outbreak. Restrictions imposed during the pandemic, social isolation, and the cancellation of medical appointments likely resulted in stress that may have affected pregnant women adversely. AIMS: To determine the psychometric validity of the Italian version of the Pandemic-Related Pregnancy Stress Scale (PREPS) in assessing COVID-19-related stress in pregnant women and to examine correlations between PREPS scales and symptoms of anxiety and depression. METHODS: 232 pregnant women attending the Obstetric-Gynecologic Clinic of an Academic Hospital were assessed with the PREPS, the Revised Prenatal Distress Questionnaire (NuPDQ), the General Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-2 (PHQ-2). We analyzed the internal consistency and factor structure of the PREPS. Convergent validity was examined by comparison with the NuPDQ. PHQ-2 and GAD-7 were used to measure the association with depression and anxiety. RESULTS: Acceptable-to-good internal consistency was found for the three PREPS scales: Preparedness Stress (PS, α=0.760), Prenatal Infection Stress (PIS, α=0.857), and Positive Appraisal (PA, α=0.747). Correlations of the NuPDQ with both PREPS stress scale scores (PS and PIS) were statistically significant, but on multiple regression analysis only the PS scale was correlated with the NuPDQ. Prenatal infection stress predicted GAD-7 score, while Preparedness stress predicted PHQ-2 score. LIMITATIONS: The main limitations were the small sample size and the cross-sectional design of the study. CONCLUSION: The Italian PREPS exhibited good psychometric properties and associations with clinical symptoms of anxiety and depression.

Prenatal Stress and Psychiatric Symptoms During Early Phases of the COVID-19 Pandemic in Italy.

PURPOSE: In February 2020, Italy became the first European country to face the coronavirus disease 2019 (COVID-19) outbreak. The concerns of infection, financial worries, loss of freedom, and isolation during the ongoing pandemic can lead to negative psychological effects, including anxiety, depression, and obsessive-compulsive disorder. The main aim of our study was to evaluate the relationship between pandemic-related stress and pregnancy-specific stress and assess their role in the development of psychiatric symptoms. We predicted that pregnancy-specific stress would mediate an association of pandemic-related stress with psychiatric symptoms. PATIENTS AND METHODS: A total of 258 pregnant women were assessed for general emotional symptoms with the General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2), and an Obsessive-Compulsive Disorder screening (OCD). The Revised Prenatal Distress Questionnaire (NuPDQ) and the Pandemic-Related Pregnancy Stress Scale (PREPS) were administered as measures of pregnancy-specific stress (PSS and pandemic-related, respectively). Mediation effects by NuPDQ for PREPS stress scales on psychiatric outcomes were calculated, using regression series and correcting for general covariates. RESULTS: Almost a third of the sample reported clinically relevant anxiety levels (32.6%), 11.2% were positive for OCD screening and less than 5% were positive for depression screening. The stress related to feeling unprepared for delivery and postpartum (PREPS-PS) predicted PHQ-2 score, both directly and indirectly via PSS, and it predicted GAD-7 score only indirectly. The stress related to fear of infection (PREPS-PIS) was directly associated to GAD-7 score and - through PSS - to PHQ-2 score and OCD. CONCLUSION: The pandemic onset contributed to poor mental health, especially anxiety, in a substantial portion of Italian pregnant women. Our results emphasize the importance of strategies to reduce pregnancy-specific stress, as well as to diminish stress due to the pandemic. Identifying risk factors for psychological suffering is important to prevent potential long-term consequences for mothers and their offspring.

COVID-19 pandemic in an Italian obstetric department: sharing our experience.

BACKGROUND AND AIM OF THE WORK: The outbreak of the novel coronavirus (or SARS-CoV 2) has significantly struck the healthcare system worldwide. Over the course of a few weeks, hospitals reorganized their internal structure entirely at any level of care, from the Emergency rooms to Departments, including all the medical specialties. METHODS: In order to cope with the contingent state of emergency, the Gynecology and Obstetrics Unit of the University Hospital in Udine introduced new protocols and guidance for the usual standard of care, ensuring a safe environment for both healthcare providers and patients. RESULTS: By a continuous update of scientific evidence, the department was able to increase capacity as well as maintain flexibility when a higher number of admissions was required. CONCLUSION: We aimed to share our experience, which provided a relevant lesson about what to expect and how to prepare a referral center for high-risk pregnancy in response to a pandemic such as COVID-19.