This is the first mental health investigation aims, in part, to evaluate risk factors for mental health problem of pregnancy women with and without the pandemic of COVID-19 in Wuhan, China. Firstly, we found that rates for anxiety, depression and stress were high, especially for these suffered from the pandemic of COVID-19. There was no difference in the rate of adverse mental health outcomes between each pregnancy trimester. Secondly, the COVID-19 pandemic had significant adverse impacts on maternal moderate-to-several anxieties and depression. We also found that pregnant women with pre-pregnancy obesity, higher educational level or good sleep quality might have lower risks for anxiety, depression and stress compared with the referenced groups.
In our study, there were 23.09% and 4.72% pregnant women suffering for mild or moderate-to-several anxieties under the pandemic of COVID-19, while the percentage were 21.53% and 3.06% for those who did not go through the COVID-19 outbreaks; the moderate-to-several depression rate was 11.35% and 0.51% with or without the pandemic of COVID-19, respectively. Recent studies reported that the outbreak of COVID-19 had impacts on mental health for different kind of populations with impacts on different degrees[6, 9, 13]. For instance, Wang et al. conducted a longitudinal study on the general population during the COVID-19 in China found that the moderate-to-severe anxiety, depression and stress were noted in 28.8%, 16.5%, and 8.1%, respectively[13]; while Cao et al. announced that the 0.9% of the medical college students were experiencing severe anxiety, 2.7% moderate anxiety, and 21.3% mild anxiety[12]. Obviously, the anxiety and depression rates were much higher in our population than in the general ones and medical college students[12]. This may for one part is caused by the global emergency of COVID-19 outbreaks[1, 25, 26]; for another, higher virginal bleeding rate and insomnia rate could also contribute to the high anxiety and depression rates as reported in previous studies[27, 28]. Interestingly, the stress level for those going through the COVID-19 pandemic was much lower than the non-epidemic ones. This might be because, firstly, participants in our study were not infected by the COVID-19 and most families had no members infected; secondly, during the COVID-19 outbreaks, among the 784 participants in our study, only 2 women did not have accompany, the others had at least one companion, mostly their husband, which may make they feel easier[29]; thirdly, they did not need to work during this period, while in the general time, most women keep working during pregnancy (in the HBC study, 66.12% women went to work during pregnancy).
Our study confirmed that anxiety, depression and stress levels had no significant difference during the whole pregnancy and perinatal periods, which was in accordance with results from those populations that did not go through the COVID-19 pandemic[30, 31]. We also found that these with higher educational level had less anxiety and depression problems. This result could be explained in two aspects. Firstly, higher educational level usually correlated with higher family income, which make the pregnant women less worries about the economic foundations, as there is an expenditure caused by pregnancy, delivery and rising the child. Secondly, women with higher educational level could had a better understanding of the process of pregnancy, delivery and rising child, and better respond to emergencies. Interestingly, results from our study shown that maternal pre-pregnancy obesity was a protective effect for anxiety, depression and stress during pregnancy both with and without the COVID-19 pandemic, which was opposite from the results of 1621 women involved in the Australian Longitudinal Study of Women’s Health[32]. The difference in the outcome may contribute to the difference in culture. In China, well goes a saying “laugh and grow fat”, which means that fat people tend to be more broad-minded, or there is a high rate that broad-minded ones are fat. According to this theory, the obesity women may be easier to accept the emergency of the COVID-19 pandemic and be less anxiety and depression.
Our study highlights some public health implications. Firstly, the pandemic of COVID-19 could increase the anxiety and depression risks for pregnant women. Public health policies and clinical interventions should be made to help these who had been suffered from or being suffering from this crisis. What’s more, participants in our study were not infected, these infected ones should have a higher anxiety and depression rate and more attentions should be paid. Secondly, the stress level for these going through the pandemic was lower than before. Although reason for this is not investigated in our study, according to the characteristics of this pandemic, we inferred that family accompany and out of work may be benefit for pregnant women and advocated that family members take more time with pregnant women. Thirdly, we found that the obesity and with high educational level ones had lower anxiety and depression risks, which indicated that holding more knowledge, supports and self-confidence could make a one better and stronger, especially during pregnancy. There are several limitations in our study. Firstly, sleep quality assessment was not in accordance in the two studies. To serve these problem, we merged sleep quality in the two studies into good or bad sleep quality, which could, from a large distance, make it comparable in the analysis. Secondly, in the HBC study, most investigation about mental health were done during 20 to 28 weeks gestation; while in the NCP study, mostly were conducted during perinatal periods. This may make our comparison powerless. However, we analyzed the correlation between the investigation gestational week and mental health problem, no significant difference was found, which suggested that our comparison was feasible.