Evaluating the Reliability and Validity of the Korean Version of the Pandemic-Related Pregnancy Stress Scale.

Purpose: This study aimed to translate the Pandemic-Related Pregnancy Stress Scale into Korean and validate the translated instrument. Patients and Methods: After translating the instrument, seven items of two factors (preparedness and perinatal infection stress) were selected for content validity testing. Validity and reliability were evaluated using SPSS 25.0 and AMOS 26.0. An online survey, via Google Forms, was conducted from January 20 to January 26, 2022. Participants were 283 pregnant women in Korea who consented to participate in the study. Results: Exploratory factor analysis revealed factor loadings on two factors of 0.64-0.87 with a total variance explained of 69.77%. Confirmatory factor analysis indicated good model fit (RMR = 0.03, RMSEA = 0.06, GFI = 0.98, SRMR = 0.03), and convergent and discriminant validity were established. Concurrent validity was established based on the correlation with the Revised Prenatal Distress Questionnaire (r = 0.45), and the reliability of the final instrument was indicated by Cronbach's α = 0.87. Conclusion: The Pandemic-Related Pregnancy Stress Scale was validated for use in the Korean population. The Korean version of the Pandemic-Related Pregnancy Stress Scale can be utilized to measure pandemic-related stress in pregnant women.

Psychometric properties of the Greek versions of the Pandemic-Related Pregnancy Stress Scale and the Pandemic-Related Postpartum Stress Scale and associated risk factors during the second year of the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has affected perinatal mental health. Reliable tools are needed to assess perinatal stress during pandemic situations. AIMS: To assess the psychometric properties of the Greek versions of the Pandemic-Related Pregnancy Stress Scale (PREPS) and the Pandemic-Related Postpartum Stress Scale (PREPS-PP) and to explore the associations between women's characteristics and perinatal stress during the second pandemic wave. METHODS: The PREPS and PREPS-PP were completed by 264 pregnant and 188 postpartum women, respectively, who also completed the State-Trait Anxiety Inventory (STAI) and the Edinburgh Perinatal Depression Scale (EPDS). RESULTS: The internal consistency was similar for PREPS and PREPS-PP. It was good for preparedness stress (a = 0.77 and α = 0.71, respectively) and infection stress (α = 0.83 for both scales) but low for positive appraisal (α = 0.46 and α = 0.41, respectively). Of the pregnant women, 55.33% and 55.27%, respectively, reported scores of ≥40 on STAI-S and STAI-T, and the respective percentages for the postpartum women were 47.34% and 46.80%. In addition, 14.39% of the pregnant women and 20.74% of the postpartum women scored ≥13 on the EPDS. Higher preparedness stress on PREPS and PREPS-PP was associated with primiparity (P = 0.022 and P = 0.021, respectively) and disrupted perinatal care (P = 0.069 and P = 0.007, respectively). In postpartum women, higher infection stress was associated with chronic disease (P = 0.037), primiparity (P = 0.02) and perceived risk of infection (P = 0.065). Higher score on infection stress was associated with disrupted perinatal care in both groups (P = 0.107 and P = 0.010, respectively). CONCLUSIONS: The Greek versions of PREPS and PREPS-PP are valid tools for the assessment of women at risk of perinatal stress during a health crisis.

Experiencing Pregnancy during the COVID-19 Lockdown in Poland: A Cross-Sectional Study of the Mediating Effect of Resiliency on Prenatal Depression Symptoms.

The COVID-19 pandemic in Poland brought uncertainty, not only to the general population but also to women preparing for childbirth, which increased the risk of mental health illnesses during this special period of life. Resilience, which refers to positive adaptation or the ability to maintain good mental health, can be a protective factor against the development of psychiatric problems such as depressive symptoms. This study aimed to assess the protective role of resilience in the relationship of such risk factors as traumatic childbirth perception and pandemic-related pregnancy stress with prenatal depressive symptoms. The study was performed at the end of the first wave of the COVID-19 pandemic. A total of 80 pregnant women took part. A mediation analysis, an independent t-test, and a Pearson correlation analysis were conducted. The lower resilience group declared the inclusion of slightly more participants (n = 41; 51.2%); 39 women (48.8%) demonstrated a higher risk of prenatal depression. The analysis revealed a significant direct effect between pandemic-related stress and prenatal depression (ßc = 0.285, SE = 0.05, t = 2.63, p < 0.05) as well as between pandemic-related stress and resilience (ßa = -0.283, SE = 0.07, t = -2.61, p < 0.05) and between resilience and prenatal depression (ßb = -0.585, SE = 0.07, t = -6.34, p < 0.001). After the introduction of resilience as a mediator, the strength of the relationship not only decreased, but also ceased to be statistically significant (ßc' = 0.120, SE = 0.04, t = 1.29, p = 0.19), which indicates that it was in a full mediation state (R2 = 0.39, F = 25.31, p < 0.001; Z = 2.43, p < 0.05). The results indicate that in pregnant women, a high level of resilience protects them from the effects of pandemic-related stress on perinatal depression symptoms.

Development and psychometric properties of the Pandemic-Related Postpartum Stress Scale (PREPS-PP).

PURPOSE: Postpartum experiences have been adversely affected by the burdens of the COVID-19 pandemic. However, there are no well-tested measures of pandemic-specific postpartum stress. We developed a modified, postpartum version of the Pandemic-Related Pregnancy Stress Scale (PREPS) and examined the psychometric properties of this novel measure. METHODS: Online questionnaires were administered at 3-4 month intervals throughout pregnancy and postpartum to women pregnant at the start of the pandemic. This study reports psychometric properties of the Pandemic-Related Postpartum Stress Scale (PREPS-PP) among women who were administered this instrument at either of two postpartum timepoints. RESULTS: At both timepoints (n = 1301 and n = 1009), CFAs revealed good model fit of the same three-factor structure identified for the prenatal PREPS (Preparedness Stress, Infection Stress, and Positive Appraisal). All PREPS-PP subscales demonstrated good reliability (α's .78-87). Higher levels of Preparedness Stress and Infection Stress were associated with greater health and financial burdens and psychological distress. CONCLUSIONS: The PREPS-PP is a reliable and valid measure of postpartum stress related to the COVID-19 pandemic. It is a valuable tool for future research into how pandemic-related postpartum stress may affect families in the short- and long-term.

The impacts of the COVID-19 pandemic on birth satisfaction in a prospective cohort of 2,341 U.S. women.

PROBLEM: Birth satisfaction is an important health outcome that is related to postpartum mood, infant caretaking, and future pregnancy intention. BACKGROUND: The COVID-19 pandemic profoundly affected antenatal care and intrapartum practices that may reduce birth satisfaction. AIM: To investigate the extent to which pandemic-related factors predicted lower birth satisfaction. METHODS: 2341 women who were recruited prenatally in April-May 2020 and reported a live birth between April-October 2020 were included in the current analysis. Hierarchical linear regression to predict birth satisfaction from well-established predictors of birth satisfaction (step 1) and from pandemic-related factors (step 2) was conducted. Additionally, the indirect associations of pandemic-related stress with birth satisfaction were investigated. FINDINGS: The first step of the regression explained 35% of variance in birth satisfaction. In the second step, pandemic-related factors explained an additional 3% of variance in birth satisfaction. Maternal stress about feeling unprepared for birth due to the pandemic and restrictions on companions during birth independently predicted lower birth satisfaction beyond the non-pandemic variables. Pandemic-related unpreparedness stress was associated with more medicalized birth and greater incongruence with birth preference, thus also indirectly influencing birth satisfaction through a mediation process. DISCUSSION: Well-established contributors to birth satisfaction remained potent during the pandemic. In addition, maternal stress and restriction on accompaniment to birth were associated with a small but significant reduction in birth satisfaction. CONCLUSION: Study findings suggest that helping women set flexible and reasonable expectations for birth and allowing at least one intrapartum support person can improve birth satisfaction.

Elevated risk for obsessive-compulsive symptoms in women pregnant during the COVID-19 pandemic.

The COVID-19 pandemic has led to a public mental health crisis with many people experiencing new or worsening anxiety. Fear of contagion and the lack of predictability/control in daily life increased the risk for problems such as obsessive-compulsive disorder (OCD) in the general population. Pregnant women may be particularly vulnerable to such pandemic-related stressors yet the prevalence of OC symptoms in this population during the pandemic remains unknown. We examined the prevalence of OC symptoms in a sample of 4451 pregnant women in the USA, recruited via targeted online methods at the start of the pandemic. Participants completed self-report measures including the Obsessive-Compulsive Inventory-Revised and the Pandemic-Related Pregnancy Stress Scale. Clinically significant OC symptoms were present in 7.12% of participants, more than twice as high as rates of peripartum OCD reported prior to the pandemic. Younger maternal age, income loss, and suspected SARS-CoV-2 infection were all associated with higher OC symptoms. Two types of pregnancy-specific stress, pandemic-related and pandemic-unrelated, were both associated with higher levels of OC symptoms. Pandemic-related pregnancy stress predicted OC symptoms even after controlling for non-pandemic-related, pregnancy-specific stress. Elevated rates of OC symptoms were observed in women pregnant during the pandemic, particularly those experiencing elevated pandemic-related pregnancy stress. This type of stress confers a distinct risk for OC symptoms above and beyond pregnancy-specific stress and demographic factors. Healthcare providers should be prepared to see and treat more peripartum women with OC symptoms during this and future public health crises.

The role of pandemic-related pregnancy stress in preference for community birth during the beginning of the COVID-19 pandemic in the United States.

BACKGROUND: The COVID-19 pandemic introduced unparalleled uncertainty into the lives of pregnant women, including concerns about where it is the safest to give birth, while preserving their rights and wishes. Reports on the increased interest in community births (at home or in birth centers) are emerging. The purpose of this project was to quantitatively investigate psychological factors related to this birth preference. METHODS: This study included 3896 pregnant women from the COVID-19 Pregnancy Experiences (COPE) Study who were anticipating a vaginal birth. COPE Study participants were recruited online between April 24 and May 15, 2020, and completed a questionnaire that included preference with respect to place of birth and psychological constructs: fear of childbirth, basic beliefs about birth, pandemic-related preparedness stress, and pandemic-related perinatal infection stress. RESULTS: Women who preferred a community birth, on average, had less childbirth fear, had stronger beliefs that birth is a natural process, were less likely to see birth as a medical process, and were less stressed about being unprepared for birth and being infected with COVID-19. In multivariate models, higher stress about perinatal COVID-19 infection was associated with greater likelihood of preferring a community birth. The effect of perinatal infection stress on preference was stronger when preparedness stress was high. DISCUSSION: Women's birth preferences during the COVID-19 pandemic are associated with psychological processes related to risk perception. Community births are more appealing to women who view being in a hospital as hazardous because of the pandemic. Policies and prenatal care aimed to increase access to safe in-hospital and out-of-hospital birth services should be encouraged.

Vulnerability and resilience to pandemic-related stress among U.S. women pregnant at the start of the COVID-19 pandemic.

RATIONALE: Women pregnant during the COVID-19 pandemic are experiencing moderate to high levels of emotional distress, which has previously been shown to be attributable to two types of pandemic-related pregnancy stress: stress associated with feeling unprepared for birth due to the pandemic (Preparedness Stress) and stress related to fears of perinatal COVID-19 infection (Perinatal Infection Stress). OBJECTIVE: Given the well-documented harms associated with elevated prenatal stress and the critical importance of developing appropriately targeted interventions, we investigated factors predictive of pandemic-related pregnancy stress. METHOD: Between April 25 and May 15, 2020, 4,451 pregnant women in the U.S. were recruited via social media to complete an online questionnaire that included sociodemographic, medical, and COVID-19 situational factors, as well as the Pandemic-Related Pregnancy Stress Scale (PREPS). Binary logistic regression was used to calculate odds ratios for high stress. RESULTS: Nearly 30% of participants reported high Preparedness Stress; a similar proportion reported high Perinatal Infection Stress. Abuse history, chronic illness, income loss due to the pandemic, perceived risk of having had COVID-19, alterations to prenatal appointments, high-risk pregnancy, and being a woman of color were associated with greater levels of one or both types of stress. Access to outdoor space, older age, and engagement in healthy behaviors were protective against stress. CONCLUSIONS: Practices that may alleviate pandemic-related stress such as minimizing disruptions to prenatal care, ensuring access to outdoor space, and motivating engagement in health behaviors are of vital importance. Particular attention is needed for more vulnerable populations including women of color, women with a history of abuse, and those with high-risk pregnancy. Research focused on the short and longer-term impact of pandemic-related pregnancy stress on maternal mental and physical health, perinatal outcomes, and child development is critical to identify these effects and marshal appropriate resources to reduce them.

Psychometric properties of the Pandemic-Related Pregnancy Stress Scale (PREPS).

PURPOSE: Pregnant women are facing numerous COVID-19 related burdens including social isolation, financial insecurity, uncertainty about the impact of the virus on fetal development, and prenatal care restrictions. We tested the psychometric properties of a new instrument designed to assess the extent and types of pandemic-related stress experienced by pregnant women. MATERIALS AND METHODS: 4,451 pregnant women from across the U.S. were recruited via social media and completed an online questionnaire in April-May 2020. The questionnaire included measures of psychological, sociodemographic, and obstetric factors and the new Pandemic-Related Pregnancy Stress Scale (PREPS). RESULTS: Confirmatory factor analyses of the PREPS showed excellent model fit. Three factors - Perinatal Infection Stress (5 items), Preparedness Stress (7 items), and Positive Appraisal (3 items) - converged and diverged with expected psychological factors, and scales created from these factors demonstrated acceptable to good reliability (α's 0.68-0.86). In addition, mean PREPS scores were associated with perceived risk of infection, and with financial and vocational COVID-19 related burdens. CONCLUSION: The PREPS is a robust instrument to assess multidimensional COVID-19 pandemic prenatal stress. It is a valuable tool for future research to examine vulnerability to pandemic stress and how this stress may affect women and their offspring.