Depression, anxiety and stress among HIV-positive pregnant women in Ethiopia during the COVID-19 pandemic.

BACKGROUND: Assessing the maternal mental health status during the coronavirus disease 2019 (COVID-19) pandemic is necessary to prevent the occurrence of severe mental disorders. Prenatal depression, anxiety and stress disorders are prominent in pregnant women living with human immunodeficiency virus (HIV) and highly associated with poor maternal and neonatal outcomes. Therefore this study aimed to assess the level of depression, anxiety, and stress among HIV-positive pregnant women in Ethiopia during the COVID-19 pandemic. METHODS: An institution-based cross-sectional study was conducted in Amhara region referral hospitals from 17 October 2020 to 1 March 2021. A systematic random sampling technique was used to select 423 eligible women. A structured, pretested and interviewer-administered questionnaire was employed to collect the data. A multivariable logistic regression analysis was implemented to identify factors associated with women's depression, anxiety and stress. Statistical association was certain based on the adjusted odds ratio (AOR) with its 95% confidence interval (CI) and p-values ≤0.05. RESULTS: Prenatal depression, anxiety and stress among HIV-positive pregnant women were 37.6% (95% CI 33 to 42.3), 42.1 (95% CI 37.7 to 46.7) and 34.8% (95% CI 30.3 to 39.2), respectively. Having an HIV-negative sexual partner (AOR 1.91 [95% CI 1.16 to 3.15]) and being on antiretroviral therapy >1 year (AOR 2.18 [95% CI 1.41 to 3.36]) were found to be statistically significant with women's antenatal depression, while unplanned pregnancy (AOR 1.09 [95% CI 1.02 to 2.33]) and did not discuss with the sexual partner about HIV (AOR 3.21 [95% CI 2.12 to 7.07]) were the factors associated with prenatal anxiety. CONCLUSIONS: In this study, more than one in three HIV-positive pregnant women had depression and anxiety. Thus, implementing strategies to prevent unplanned pregnancy and advocating open discussion with sexual partners about HIV will play a large role in reducing pregnancy-related depression and anxiety.

Association of social capital with mental health and quality of life among low- and high-risk pregnant women.

INTRODUCTION: Social capital means having resources and support in relationships and social ties. It can affect the individual's quality of life and mental health. The present study investigated the association between social capital with psychological status and quality of life among low-risk and high-risk pregnant women. METHODS: The present cross-sectional study was conducted with the participation of 394 pregnant women receiving prenatal care in urban comprehensive health centers in Qazvin, Iran. Two-stage sampling was used to select comprehensive health centers by random cluster sampling and then pregnant women randomly. Social capital, quality of life (QoL), psychological status, and demographic and obstetric characteristics were assessed. Uni-variable and multivariable linear regression models were used to analyze the data. RESULTS: Among the participants, 267 had low-risk pregnancies (67.77%) and the remainder were high-risk. The mean age of participants was 27.94 years (SD=5.86), the mean gestational age was 23.63 weeks (SD=7.71). The mean overall quality of life score among low-risk pregnant women was 32.00 (SD=5.27) and among high-risk pregnant women was 29.70 (SD=3.65). High-risk pregnant women experienced significantly higher anxiety and depression and fear of COVID-19. Social capital had a significant and weak relationship with anxiety among low-risk pregnant women (r = 0.22, p < 0.001). Also, a weak and significant relationship between social capital and anxiety (r = 0.24, p = 0.007), depression (r = 0.24, p = 0.007) and fear of COVID-19 (r = 0.27, p = 0.002) was found among high-risk pregnant women. CONCLUSION: Women with high-risk pregnancies experienced lower quality of life, higher anxiety and depression, and greater fear of COVID-19. There was also a weak relationship between social capital and the aforementioned variables among high-risk pregnant women. Designing and implementing interventions to increase quality of life and reduce anxiety and stress among high-risk pregnant women appears to be warranted.

Anxiety and depression among pregnant women undergoing IVF-ET and WeChat group peer support during the COVID-19 pandemic: Study protocol for a randomized controlled trial.

INTRODUCTION: The psychological well-being of pregnant women following assisted reproductive has increasingly gained attention in recent years. Anxiety and depression may be associated to pregnancy outcomes. This study aims to determine whether peer support and the WeChat group platform will reduce anxiety and depression among in vitro fertilization and embryo transfer (IVF-ET) women. METHODS AND ANALYSIS: In the present randomized controlled study, 296 patients with confirmed clinical pregnancy following IVF-ET will be randomly assigned to receive standard intervention support or WeChat peer support on a 1:1 basis. The levels of anxiety and depression are the primary endpoints. Assessments will be performed at baseline measurements, first trimester, second trimester, and third trimester, and data will be collected. ETHICS AND DISSEMINATION: This study has been approved as ethical by the affiliated hospital of Shandong University of Traditional Chinese Medicine's Reproductive Ethics Committee. Each patient will sign a written statement of informed permission. All information and biological samples will be legally protected. A peer-reviewed academic journal will publish the findings of this investigation. DISCUSSION: Given the inconvenience of visits due to the current pandemic of COVID-19, this study addresses the patient's visit needs by combining WeChat, the most widely used social software in China, with peer support, while helping improve maternal anxiety, depression, and pregnancy outcomes following IVF-ET.

COVID-19 anxiety and quality of life among adolescent pregnant women: a cross-sectional study.

OBJECTIVES: To determine the relationship between the COVID-19 anxiety and the quality of life among adolescent pregnant women in Dashtiari city, Iran. METHODS: In this cross-sectional study, 216 adolescent pregnant women in Dashtiari city, Iran in 2021 who met the inclusion criteria participated in a multi-stage sampling. Data collection tools included: demographic information, COVID-19 Anxiety Scale and a questionnaire of quality of life. Finally, the obtained data were analyzed in SPSS software version 21 using descriptive, Chi-square, Tukey and logistic regression tests. RESULTS: The results showed that 74 (34.3%) adolescent pregnant women had weak COVID-19 anxiety, 23 (10.6%) had moderate COVID-19 anxiety and 119 (55.1%) had severe COVID-19 anxiety. The results also showed that gestational age (OR=2.2, p=0.03), history of COVID-19 infection among adolescent pregnant women (OR=1.6, p=0.02), history of family and friends (OR=1.7) (p=0.04), quality of life (OR=4.3, p=0.001), increases the probability of COVID-19 anxiety. CONCLUSIONS: Considering the psychological consequences of the post-COVID-19 era and the psychological events that occur in this period, by identifying and predicting these issues, strategies should be considered for optimal intervention and reduction of injuries in the post-crisis era.

Antenatal care of pregnant women during pandemic: A phenomenology study.

Objectives: To assess the experience of pregnant women related to antenatal care during the coronavirus disease-2019 pandemic. Method: The qualitative interpretive phenomenology study was conducted from July to September 2022 in Lamongan General Hospital after approval from Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia. The sample comprised pregnant women at very high risk in the third trimester during the coronavirus disease-2019 pandemic. Data was collected from the medical records, and subsequently through semi-structured interviews. Data was analysed using the Braun and Clarke thematic analysis. RESULTS: Of the 19 subjects with a mean age of 33.3±4,91 years, 11 (58%) had studied up to high school level and 16(84%) were housewives. There were 5 themes that had a total of 14 sub-themes. The themes were fear of getting pregnant during a pandemic, afraid of losing her baby, losing the support system, adherence to health protocols, and differences in healthcare systems. CONCLUSIONS: Pregnancy during the pandemic had an impact on the physical and mental health of women and turned into a terrifying experience. Health workers need to pay attention to the physical and psychological conditions of pregnant women, including antenatal care services that must be provided at least six times directly or by using telemedicine.

Social distancing and mental health among pregnant women during the coronavirus pandemic.

BACKGROUND: The effect of social distancing due to the COVID-19 pandemic on the mental health of pregnant women is of particular concern, given potential effects on physical health, family functioning, and child development. METHODS: Pregnant women were recruited for the "Implications of and Experiences Surrounding being Pregnant during the COVID-19 Pandemic" study at Woman's Hospital in Baton Rouge, Louisiana. Participants enrolled at any point during their pregnancy and surveys were delivered weekly until the participant indicated that she had delivered her baby; a postpartum survey followed four weeks after delivery. This analysis includes 1037 participants with baseline, 596 with follow-up, and 302 with postpartum surveys. Questions on social distancing behaviors were asked at baseline and grouped based on whether they involved social distancing from work, friends and family, or public places. Symptoms of anxiety, stress, depression, and pregnancy-related anxiety were measured. Each type of social distancing was examined as a predictor of mental health using linear model with control for confounders. RESULTS: The study population was largely white (84.1%), married (81.8%), and educated (76.2% with a bachelor's or higher degree). Women who were younger, Black, unmarried, or had less education or income reported fewer social distancing behaviors. Mean anxiety score in the highest quartile of overall social distancing was 8.3 (SD 5.6), while in the lowest quartile it was 6.0 (SD 5.0) (p < 0.01), while perceived stress postpartum and pregnancy-related stress were not associated with social distancing. Associations were substantially diminished when controlled for baseline levels of anxiety symptoms. CONCLUSIONS: Greater social distancing was associated with more anxiety symptoms, but worse mental health, particularly anxiety, may also have contributed to greater social distancing behaviors.

Mental health of pregnant women during the SARS-CoV-2 pandemic in France: Evolution of self-perceived psychological state during the first lockdown, and anxiety frequency two months after the lockdown ended.

Previous pandemics and related lockdowns have had a deleterious impact on pregnant women's mental health. We studied the impact of the SARS-CoV-2/Covid-19 pandemic and France's first lockdown on pregnant women's mental health. A cross-sectional study was conducted in July 2020 using a web-questionnaire completed by 500 adult women who were pregnant during the first lockdown in France (March-May 2020). Questions focused on their self-perceived psychological state and affects they felt before and during the lockdown and anxiety symptomatology (HAD) two months after it ended. A robust variance Poisson regression model was used to estimate adjusted prevalence ratios (aPR) for anxiety and self-perceived psychological state evolution. One in five respondents (21.1%) reported psychological deterioration during lockdown. Associated determinants were: i) little or no social support (self-perceived) (aRP = 1.77, 95%CI[1.18-2.66]), ii) increased workload (1.65, [1.02-2.66]), and iii) poor/moderate knowledge about SARS-CoV-2 transmission (1.60, [1.09-2.35]). Seven percent of women reporting psychological deterioration had access to professional psychological support during lockdown, while 19% did not despite wanting it. Women reported heightened powerlessness (60.3%), frustration (64%) and fear (59.2%) during lockdown. One in seven respondents (14.2%, 95%CI[10.9-18.2]) had anxiety symptoms. Determinants associated: i) at least one pregnancy-related pathology (aPR = 1.82, 95%CI[1.15-2.88]), ii) overweightness or obesity (1.61, [1.07-2.43]), iii) one child under the age of six years in the household during the lockdown (3.26, [1.24-8.53]), iv) little or no social support (self-perceived) during the lockdown (1.66, [1.07-2.58]), v) friend or relatives diagnosed with Covid-19 or with symptoms of the disease (1.66; [1.06-2.60]), vi) no access to medication for psychological distress (2.86, [1.74-4.71]), and vii) unsuccessfully seeking exchanges with healthcare professionals about their pregnancy during the pandemic (1.66, [1.08-2.55]). Our results can guide prevention and support policies for pregnant women during pandemics, current or future, with or without lockdowns. Preventing perinatal mental health problems is essential to ensure a supportive environment for the child's development.

STEP-COVID: a pilot study of a prenatal intervention for pregnant women during the COVID-19 pandemic.

The COVID-19 pandemic has been associated with a global increase in psychological distress in pregnant women. This study evaluated the effects of STEP-COVID, a six-session mentalization-based prenatal group program offered online during the COVID-19 pandemic. The 100 participants were allocated to STEP-COVID or to the natural trajectory of prenatal care. Pre- and post-intervention assessments included measures of psychological distress, post-traumatic symptoms and positive affectivity. Perception of change during pregnancy on resilience-promoting factors was also assessed at post-intervention. A significant decrease in psychological distress and post-traumatic symptoms and an increase in positive affectivity were observed in participants in the intervention condition, whereas only post-traumatic symptoms improved in the control condition. Women who participated in STEP-COVID also reported greater changes during pregnancy on resilience-promoting factors than women in the control condition. Results hold promise for buffering the effect of the pandemic on the mental health of pregnant women using brief online interventions. Clinical trial registration: NCT05419167 (15/06/2022).

The Impact of COVID-19 Related Distress on Antenatal Depression in Australia.

Globally, the impact of COVID-19 on mental health has been significant. Pregnant women are known to be a vulnerable population in relation to mental health. In Australia, there was an unprecedented demand during the pandemic for mental health services, including services for pregnant women. Maternal mental health has unique and enduring features that can significantly shape a child's overall development and poor maternal mental health can have considerable social and economic costs. This cross-sectional study evaluated symptoms of antenatal depression and COVID-19-related distress in a sample of two hundred and sixty-nine pregnant women residing in Australia aged between 20 and 43 (M = 31.79, SD = 4.58), as part of a larger study. Social media advertising was used to recruit participants between September 2020 and November 2021. Prevalence rates for antenatal depression were found to be higher in this study (16.4%) compared with previous Australian prevalence rates (7%). COVID-19 distress in relation to having a baby during a COVID-19 outbreak significantly predicted symptoms of antenatal depression, B = 1.46, p < 0.001. Results from this study suggest that mothers and families may have increased mental health vulnerabilities as a consequence of the pandemic for some time yet.

Unplanned Pregnancy and Depressive Symptoms during the COVID-19 Pandemic.

This is a cross-sectional study conducted with pregnant women who underwent prenatal care at basic health units in São Luís City, Maranhão State, Brazil. The authors used a semistructured questionnaire to assess the socioeconomic, demographic, and clinical characteristics of pregnant women as well as the Edinburgh Scale to investigate depressive symptoms. In order to assess the association between the explanatory variable and the outcome variable, Poisson logistic regression was performed with statistical significance at p < 0.05. A total of 205 women were interviewed, most aged between 18 and 29 years (66.83%). Of this total, 74.63% had not planned their pregnancy and 26.67% had depressive symptoms. The variables unplanned pregnancy (PR = 1.41; CI = 0.99−2.00; p = 0.05) and not undergoing psychological counseling (PR = 1.42; CI = 0.51−0.83; p ≤ 0.01) correlated with depressive symptoms during pregnancy. It is thus possible to link the variables unplanned pregnancy (p > 0.05) and not undergoing psychological counseling (p = 0.001) to depression. Therefore, it is important to monitor the mental health of pregnant women, especially in situations of vulnerability.

Depression Among Portuguese Pregnant Women During Covid-19 Lockdown: A Cross Sectional Study.

INTRODUCTION: Coronavirus disease 2019 was declared as a pandemic on March 2020. Research on its psychological effects is still lacking. Perinatal depression is a medical complication of pregnancy, especially in situations of stress. In this study, we aimed to investigate the presence of symptoms of depression in pregnant women during the lockdown period in Portugal. METHODS: This study consisted in a cross-sectional study among Portuguese pregnant women, who completed an online self-report questionnaire between 25th April and 30th April 2020. An anonymous online questionnaire was developed to assess depression and concerns related to COVID-19. This study was approved by the IRB of Hospital Dona Estefânia and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. Eligibility criteria included pregnant women, ≥ 18 years and living in Portugal. The primary outcome was to evaluate the presence of depressive symptoms and its association to socio-demographic characteristics and to concerns related to COVID-19. RESULTS: A total of 1698 pregnant women were enrolled. The mean age was 31.9 years. 82.4% felt a negative impact of the pandemic in the surveillance of pregnancy and 43% felt insufficient support. 26.3% showed "possible depression" according to the EPDS. A regression analysis revealed the possibility of depression increased as the concerns about COVID increased and was lower for women with support. The possibility of depression was higher for women with psychiatric medical history. CONCLUSION: This study demonstrated a significant increase in clinically significant depressive symptoms in pregnant women during the lockdown. It also revealed some of the socio-demographic characteristics of women at risk for depression. If left untreated, depression tends to persist, affecting the woman and also the child. Our findings suggest that COVID-19 represents a serious challenge for this population and reinforce the urgent need for early detection and intervention on mental health issues during pregnancy, especially during the pandemic.

Pregnant Women's experiences with intimate partner violence one year after the COVID-19 pandemic in Jordan.

AIM: To assess the prevalence and compare the levels of intimate partner violence (IPV) before and during the pandemic and to identify the factors that associated with physical IPV among Jordanian pregnant women. DESIGN: A cross-sectional, correlational design. Women were asked to report their experience with IPV twice: during and before the pandemic. METHODS: A convenience sampling technique was used to select pregnant women from National Woman's Health Care Center from 15 April to 1 September 2021. The Domestic Violence Questionnaire Screening Tool (DVQST) was used to assess the levels of IPV. RESULTS: The women (n = 232) who participated in the study experienced considerable levels of IPV before (69% control IPV, 59.90% psychological, 46.10% physical, 43.10% sexual) and during (75.90% control IPV, 64.20% psychological, 46.10% physical, 40.90% sexual) the pandemic. There were statistically significant (p ≤ 0.05) higher mean DVQST scores for control IPV and psychological IPV during the pandemic (control IPV mean = 9.78, psychological mean = 7.03) versus before the pandemic (control IPV mean = 8.95, psychological mean = 6.62). Woman's educational level, marriage duration, woman's employment status, and level of mutual understanding were inversely associated with physical IPV during the pandemic. PATIENT OR PUBLIC CONTRIBUTION: IPV is a global public health problem and a major violation of human rights. The levels of control IPV and psychological IPV increased during the COVID-19 pandemic, while the levels of physical and sexual IPV stayed the same. Antenatal screening for IPV is crucial to save women and their offspring from suffering this type of violence.

Contributors to COVID-19-Related Childbirth Anxiety among Pregnant Women in Two Pandemic Waves.

COVID-19 has impacted all levels of daily life for people everywhere, with particularly serious implications for pregnant women. This paper examines the COVID-19-related childbirth anxiety (CCA) of Israeli women in the first two waves of the pandemic. We first present two psychotherapeutic case studies with pregnant women in the two waves. This is followed by an empirical study that compared the contribution of background variables, psychological distress, economic concerns, and personal resources to CCA in two samples, Wave 1, March-April 2020 (n = 403) and Wave 2, September-October 2020 (n = 1401), and two subpopulations, Jewish and Arab women. Findings reveal that CCA was significantly lower in Wave 2 than in Wave 1. Furthermore, poorer health, higher education, being an Arab, later gestational week, at-risk pregnancy, wave, higher psychological distress, greater economic concerns, and lower self-compassion contributed to higher childbirth anxiety. Wave moderated the association between optimism and anxiety. The findings of the empirical study, together with insights from the case studies, provide evidence of a decrease in CCA later in the crisis, and indicate the significance of resources for coping with the psychological implications of the pandemic. Moreover, they suggest the importance of empowering self-reliance techniques, such as self-compassion, which was significantly associated with lower anxiety, above and beyond the background and psychological variables. Clinical Impact Statement: Using both psychotherapeutic cases and empirical findings, this study points to the risk and resilience factors that contributed to pregnant women's COVID-19-related childbirth anxiety (CCA) in the first two waves of the pandemic. The study suggests that CCA was higher in the first wave, as well as among women from a minority group. At the same time, the research shows that resilience resources of optimism and self-compassion contributed to the reduction of anxiety. These findings may guide interventions for the vulnerable group of pregnant women in times of crisis.

Factors Associated with Post-Traumatic Stress Symptoms in Pregnant and Postpartum Women.

Background: Evidence of post-traumatic stress disorder (PTSD) symptoms related to the COVID-19 pandemic during the perinatal period and the associated risk factors are still limited. Thus, we aimed to investigate the PTSD symptoms associated with the COVID-19 pandemic in a large sample of both pregnant and postpartum women. Methods: A cross-sectional study was conducted on 3319 pregnant and up to 6-month postpartum women from Spain. An online survey was completed between June 2020 and January 2021. The assessment included measures of PTSD symptoms associated with COVID-19 (evaluated with 10 questions from the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), pandemic-related concerns and health background (assessed by the Coronavirus Perinatal Experiences-Impact Survey), and demographic characteristics. Results: We found that >40% of women suffered from symptoms of PTSD associated with the COVID-19 pandemic. Difficulty concentrating and irritability were the most common symptoms, showing marked alterations in arousal and reactivity associated with the traumatic event. Being younger, suffering from pandemic concerns and distress, changes due to the pandemic and previous mental health problems were risk factors associated with PTSD symptoms in perinatal women. In addition, whereas being an immigrant (non-Spanish) was a risk factor for pregnant women, having other children and financial problems were risk factors for postpartum women. COVID-19 infection did not appear to be a risk factor for symptoms of PTSD in perinatal women. Conclusions: The increased risk of PTSD in pregnant and postpartum women highlights the importance of early detection and treatment of PTSD for pregnant and postnatal women, both during and beyond the pandemic. Trial Registration: ClinicalTrials.gov Identifier (NCT04595123).

Correlations between attitudes towards the COVID-19 vaccine and psychiatric symptoms among pregnant women.

OBJECTIVE: As data continue to show that COVID-19 vaccines are safe for pregnant women, determining the factors that affect their attitudes towards vaccines has become increasingly important. Pregnancy increases the risk of depressive and obsessive-compulsive (OC) symptoms. We aimed to determine the correlations between psychiatric symptoms and attitudes towards vaccination in pregnant women. METHODS: A total of 100 pregnant women were enrolled in the present cross-sectional study. We used a standard data form to obtain the participants' sociodemographic and clinical characteristics. The Attitudes Towards the COVID-19 Vaccine Scale, the Maudsley Obsessive-Compulsive Inventory (MOCI) and the Depression Anxiety Stress Scale (DASS-21) were used to measure attitudes towards vaccination and psychiatric symptoms. We then investigated the correlations between the scale scores. RESULTS: There was a significant correlation between positive, negative, and total attitudes towards vaccines and MOCI total and subscale scores. According to the linear regression model, variables of MOCI total score, planned/unplanned pregnancy, and age were determined as the predictors for vaccination attitudes towards COVID-19 vaccines. CONCLUSION: Increased OC symptoms seem to be associated with negative attitudes towards vaccination. It is important to screen pregnant women with lower vaccination rates for OC symptoms more carefully. A multidisciplinary approach would be beneficial to increase vaccination rates.

"We Should Be Working Together, and It Felt like They Disrupted That": Pregnant Women and Partners' Experiences of Maternity Care in the First UK COVID-19 Pandemic Lockdown.

Pregnant women were identified as being at elevated risk from COVID-19 early in the pandemic. Certain restrictions were placed upon birth partners accompanying their pregnant partner to in-person maternity consultations and for in-patient maternity care. In the absence of a central directive in England, the nature of restrictions varied across maternity services. Eleven participants (seven pregnant women and four partners), who were expectant parents during the first UK COVID-19 pandemic lockdown, took part in serial interviews in pregnancy and the postnatal period. Data were subject to a reflexive thematic analysis. Four main themes were identified, with sub-themes: uncertainty and anxiety (uncertainty and anxiety about COVID-19, uncertainty and anxiety about maternity services); disruption of partnering and parenting role; complexity around entering hospital spaces (hospitals offering protection while posing threat, individual health professionals in inflexible systems); and attempting to feel in control. Separating couples may result in disruption to their anticipated roles and significant distress to both partners, with potential impacts for mental health and future family relationships. Trauma-informed perspectives are relevant for understanding parents' experiences of maternity care in the pandemic and identifying ways to improve care to promote and protect the mental health of all parents.

Prenatal Mental Representations in Italian First-Time Mothers Before and During the COVID-19 Pandemic: A Study with Interviews on Maternal Representations During Pregnancy.

INTRODUCTION: Psychosocial risks increase the levels of not-integrated/ambivalent and restricted/disengaged representations during pregnancy, but no study has specifically analysed the impact of the COVID-19 pandemic on maternal representation styles. OBJECTIVES: (1) to compare maternal representation styles in primiparous women who became pregnant before and during the COVID-19 pandemic and (2) to analyse the content of representation styles during the COVID-19 pandemic. METHODS: A total of 37 Italian pregnant women were recruited from 2019 to 2021. The sample was divided into two groups: the pre-COVID-19 group (22 women, mean age = 33.14 years; SD = 3.78) and the COVID-19 group (15 women, mean age = 35.9 years; SD = 4.6). Interviews on maternal representations during pregnancy were administered and analysed for style and content. RESULTS: Women during the COVID-19 pandemic reported more restricted/disengaged and less integrated/balanced representation styles than women pre-COVID-19. Content analysis showed that the COVID-19 pandemic led women to focus more on concrete aspects of pregnancy in lieu of emotional aspects, thus leading them to develop more restricted/disengaged representation styles. CONCLUSIONS FOR PRACTICE: In future pandemics pregnant women should be supported in focusing their attention to emotions, sensations and fantasies about themselves as mothers and their children.

Efforts and expectations of pregnant women against the impact of the COVID-19 pandemic: a phenomenological study.

BACKGROUND: COVID-19 is a global threat that directly impacts people's mental health and physical well-being. This study explored the efforts and expectations of pregnant women against the impact of the COVID-19 pandemic. METHODS: This study was a qualitative study that used a phenomenological approach. The informants of this study were pregnant women (n = 20). Data analysis used content analysis with software assistance (Nvivo Release 1.5). RESULTS: The results of this study identified three themes which were: 1) causative factors of pregnant women's anxiety regarding the impact of COVID-19 including lack of knowledge regarding the impact of the COVID-19 virus and perceived susceptibility; 2) Efforts to reduce anxiety during the COVID-19 pandemic including a spiritual approach, the role of family and COVID-19 prevention; and 3) Expectation regarding healthcare services during COVID-19 including virtual based Antenatal Care (ANC) Services and Private ANC Services. CONCLUSION: A spiritual approach, the role of family, and COVID-19 prevention will help pregnant women reduce their anxiety about being infected with the COVID-19 virus. Furthermore, virtual-based ANC Services, and private ANC services, such as home visits and dividing ANC services and general services into two different tracks as a protective mechanism from being infected with the COVID-19 virus, would assist pregnant women feel safer and secure.

Mental health of pregnant and postpartum women during the third wave of the COVID-19 pandemic: a European cross-sectional study.

OBJECTIVE: To describe the mental health of perinatal women in five European countries during the third pandemic wave and identify risk factors related to depressive and anxiety symptoms. DESIGN: A cross-sectional, online survey-based study. SETTING: Belgium, Norway, Switzerland, the Netherlands and the UK, 10 June 2021-22 August 2021. PARTICIPANTS: Pregnant and up to 3 months postpartum women, older than 18 years of age. PRIMARY OUTCOME MEASURE: The Edinburgh Depression Scale (EDS) and the Generalised Anxiety Disorder scale (GAD-7) were used to assess mental health status. Univariate and multivariate generalised linear models were performed to identify factors associated with poor mental health. RESULTS: 5210 women participated (including 3411 pregnant and 1799 postpartum women). The prevalence of major depressive symptoms (EDS ≥13) was 16.1% in the pregnancy group and 17.0% in the postpartum . Moderate to severe generalised anxiety symptoms (GAD ≥10) were found among 17.3% of the pregnant and 17.7% of the postpartum women. Risk factors associated with poor mental health included having a pre-existing mental illness, a chronic somatic illness, having had COVID-19 or its symptoms, smoking, unplanned pregnancy and country of residence. Among COVID-19 restrictive measures specific to perinatal care, pregnant and postpartum women were most anxious about not having their partner present at the time of delivery, that their partner had to leave the hospital early and to be separated from their newborn after the delivery. CONCLUSION: Approximately one in six pregnant or postpartum women reported major depression or anxiety symptoms during the third wave of the pandemic. These findings suggest a continued need to monitor depression and anxiety in pregnancy and postpartum populations throughout and in the wake of the pandemic. Tailored support and counselling are essential to reduce the burden of the pandemic on perinatal and infant mental health.

The Effect of COVID-19 on Maternal Mental Health and Medical Support.

The Coronavirus disease 2019 (COVID-19) is a pandemic that affected the overall mental health of the population. As seen in previous situations, there seemed to be an extreme impact of disasters on the mental health of pregnant women and new mothers; therefore, we investigated the relationship between COVID-19 and maternal mental health. The pregnant subjects were identified during the study period through convenience sampling. The study received Institutional Review Board approval and online surveys were sent to subjects via email. The questions were focused on feelings about being pregnant and the influence of the practices during the pandemic. Fifty-one (51) pregnant patients were identified. Our study found that 92.3% of the participants felt negatively, as the COVID-19 precautions did not permit their significant other to attend their routine prenatal visits with them. 64.7% felt that the visits were less personal, 100% felt that they had to take more precautions. Only 42% of the doctors of the subjects discussed how COVID-19 could affect the pregnancy and the baby. Pregnant subjects all had negative feelings towards the pandemic, routine precautions, and the inability to include significant others in prenatal visits and delivery. The majority did not feel their medical teams discussed how COVID-19 could affect the baby.