key: cord-0889814-dmuufxtm
authors: Wu, Yanting; Zhang, Chen; Liu, Han; Duan, Chenchi; Li, Cheng; Fan, Jianxia; Li, Hong; Chen, Lei; Xu, Hualin; Li, Xiangjuan; Guo, Yi; Wang, Yeping; Li, Xiufeng; Li, Jing; Zhang, Ting; You, Yiping; Li, Hongmei; Yang, Shuangqi; Tao, Xiaoling; Xu, Yajuan; Lao, Haihong; Wen, Ming; Zhou, Yan; Wang, Junying; Chen, Yuhua; Meng, Diyun; Zhai, Jingli; Ye, Youchun; Zhong, Qinwen; Yang, Xiuping; Zhang, Dan; Zhang, Jing; Wu, Xifeng; Chen, Wei; Dennis, Cindy-Lee; Huang, Hefeng
title: Perinatal depressive and anxiety symptoms of pregnant women along with COVID-19 outbreak in China
date: 2020-05-11
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2020.05.009
sha: d2edd07ec49a015d0331736dc9e183262a3825d7
doc_id: 889814
cord_uid: dmuufxtm

Abstract Background On January 20, 2020, a new coronavirus epidemic with “human-to-human” transmission was officially announced by the Chinese government, which caused significant public panic in China. Pregnant women may be particularly vulnerable and in special need for preventative mental health strategies. Thus far, no reports exist to investigate the mental health response of pregnant women to the COVID-19 outbreak. Objective The aim of the present study is to examine the impact of COVID-19 outbreak on the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women across China. Study Design A multi-center cross-sectional study was initiated in early December 2019 to identify mental health concerns in pregnancy using the Edinburgh Postnatal Depression Scale (EPDS). This study provided a unique opportunity to compare the mental status of pregnant women before and after the announcement of the COVID-19 epidemic. A total of 4124 pregnant women during their third trimester from 25 hospitals in 10 provinces across China were examined in this cross-sectional study from January 1 to February 9, 2020. Of these women, 1285 were assessed after January 20, 2020 when the coronavirus epidemic was publically announced and 2839 were assessed before this pivotal time point. The internationally recommended EPDS was used to assess maternal depression and anxiety symptoms. Prevalence rates and risk factors were compared between the pre and post study groups. Results Pregnant women assessed after the declaration of COVID-19 epidemic had significantly higher rates of depressive symptoms (26.0% vs 29.6%, P=0.02) than women assess pre-epidemic announcement. These women were also more likely to endorse thoughts of self-harm (P=0.005). The depressive rates were positively associated with the number of newly-confirmed COVID-19 cases (P=0.003), suspected infections (P=0.004), and death cases per day (P=0.001). Pregnant women who were underweight pre-pregnancy, primiparous, < 35 years old, employed full-time, middle income, and had appropriate living space were at increased risk to develop depressive and anxiety symptoms during the outbreak. Conclusion Major life-threatening public health events such as the COVID-19 outbreak may increase the risk for mental illness among pregnant women including thoughts of self-harm. Strategies targeting maternal stress and isolation such as effective risk communication and the provision of psychological first aid may be particularly useful to prevent negative outcomes for women and their fetuses.

Human-to-human transmission of COVID-19 was first confirmed and reported by 162 Chinese government on January 20, 2020. In early December 2019 before the 163 COVID-19 outbreak, our team initiated a multi-center cross-sectional study to 164 identify mental health concerns in pregnancy using the Edinburgh Postnatal 165 Depression Scale (EPDS). This study provided a unique opportunity to compare the 166 mental status of pregnant women before and after the announcement of the 167 COVID-19 epidemic. In order to examine the effect of a major public health 168 emergency on the mental health of pregnant women, data from January 1 to February 169 9, 2020 were obtained from the Perinatal and Postpartum Depression Information 170 Collection System we built. For this current study, all participants were categorized 171 into two groups based on whether human-to-human transmission of COVID-19 had 172 been reported when the study questionnaire was completed (group 1: before the 173 declaration of human-to-human transmission; group 2: after the declaration). placental previa and exercise. We also consider investigation sites, history of diseases, 227 use of assisted reproductive technology (ART) and twins pregnancy as potential 228 confounders, but adjustment for these variables did not change the results and 229 therefore we did not include them in the final models. We did not use imputing data 230 analyses due to no missing data. (Table 1 ). Due to the small proportion of 237 women with a history of anxiety or depression (<1%), we did not exclude them in the 238 following analyses.

Depressive and Anxiety Symptoms and COVID-19. We found that women in 240 group 2 had higher mean EPDS scores (mean ± SD: 7.7 ± 4.4 vs. 7.4 ± 4.3) and 241 anxiety subscale scores (mean ± SD: 3.4 ± 1.7 vs. 3.2 ± 1.7) than those in group 1. (Table 2) . This study examined the relationship between a major life-threatening public health 283 event and maternal mental health where there is increased stress and fear due to the 284 additional concern for an unborn fetus. After the declaration of human-to-human 285 transmission of the COVID-19 by the Chinese government on January 20, 2020, 286 global concern and uncertainty increased dramatically. A clinically significant rise in 287 the prevalence of depressive symptoms was found among pregnant women increasing 288 from 26% before January 20 to 34.2% between February 5 to 9, 2020. A significant 289 increase in anxiety symptoms was also found. The outbreak of COVID-19 may 290 contribute to a significant increase in mild depressive symptoms instead of severe 291 symptoms, as we found that the percentage of women with EPDS scores between 10 292 and 12 was higher after the COVID-19 epidemic declaration (data not shown).

Not surprising, the prevalence of depressive symptoms increased as the number 294 of death and newly-diagnosed cases also increased. Due to the sudden outbreak, the 295 features of the COVID-19 virus and symptoms remained unknown for weeks causing 296 heightened fear overall and concern for vertical transmission from mother to fetus 297 among pregnant women. Rapid reporting though news and social media eliminated 298 the regional differences such that increased rates of depressive symptoms was found 299 among pregnant women in the 10 participating provinces independent of the number 300 of cases found locally. 

Education

A novel coronavirus outbreak of global 411 health concern

Clinical management of severe acute respiratory infection when Novel 413 coronavirus (nCoV) infection is suspected: interim guidance

Clinical features of patients infected with 2019 novel 418 coronavirus in Wuhan

A familial cluster of pneumonia associated 425 with the 2019 novel coronavirus indicating person-to-person transmission: a study of 426 a family cluster

Recommendations on diagnostic criteria and 428 prevention of SARS-related mental disorders

Group 2: after the COVID-19 epidemic declaration. § COVID-19 was incorporated as a notifiable disease in the infection Law and Health and Quarantine Law in Jan/20, and it was the first time reported that the COVID-19 could spread from human to human by official media. The COVID-19 confirmed and suspected cases have rapidly increased since Jan/20. ¶ ART=Assisted Reproductive Technology. ǂ Included gestation diabetes, pre-eclampsia, gestation hypertension, intrahepatic cholestasis of pregnancy, placental previa, malposition, fetal growth restriction and high-risk pregnancy status. * Included generalised anxiety disorder, panic, agoraphobia, post-traumatic stress disorder, social phobia and depression disorder. £ Confirmed COVID-19 cases <500 in participating Chinese provinces included Shanghai

Per-capita living area ≥20 m