The prevalence of psychiatric symptoms of pregnant and non-pregnant women during the COVID-19 epidemic

The COVID-19 pandemic, originating in Wuhan, China, rapidly spread globally, causing a substantial public health crisis and significant economic burden. While the pandemic's physical effects were widely studied, its psychological impact, particularly on vulnerable populations, remained under-investigated. Previous research highlighted the considerable psychological impact on the general public, teenagers, and healthcare workers, with high rates of anxiety, depression, and PTSD reported. However, limited data existed on the mental health of pregnant women during this period. Given the increased stress associated with pregnancy and the potential for added burdens during a pandemic (e.g., limited access to prenatal care), it was crucial to assess the mental health of this specific population. Previous studies had demonstrated that significant psychological burden during pregnancy increases the risk of future mental disorders and impaired social function, while maternal mental health problems negatively impact child development. Additionally, pregnant women, with their suppressed immune systems, are at increased risk of SARS-CoV-2 infection. The difficulties in accessing routine prenatal care and childbirth during the pandemic could further exacerbate their psychological burden. This study aimed to fill this knowledge gap by comparing the prevalence of depression, anxiety, physical discomfort (somatization), insomnia, and PTSD between pregnant and non-pregnant women in China during the initial phases of the COVID-19 outbreak.

Existing literature demonstrated a significant psychological toll of the COVID-19 pandemic. Studies showed a substantial proportion of the general population experienced moderate to severe psychological impact. Similarly, research indicated high rates of anxiety and depressive symptoms among teenagers during the pandemic. A significant number of healthcare workers also reported symptoms of depression, anxiety, insomnia, and distress. However, prior to this study, the mental health consequences of the COVID-19 pandemic on pregnant women had not been comprehensively investigated. Previous research has established the link between psychological stress during pregnancy and increased risk of future mental disorders, social dysfunction in mothers, and impaired child development. The added stress of limited prenatal care access and potential health risks during the pandemic highlighted the need for focused research on the mental health of pregnant women.

This study employed a cross-sectional survey design using an anonymous online questionnaire. Data were collected from pregnant and non-pregnant women of childbearing age in several maternal and child health hospitals in Beijing, China, between February 28 and March 12, 2020. The online approach was chosen due to government-mandated stay-at-home orders during the pandemic. The survey link was disseminated through social media platforms and notifications from the participating hospitals. The questionnaire gathered socio-demographic data (age, nationality, marital status, occupation, education, height, weight, residence, smoking and drinking habits, annual family income, history of chronic diseases) and information about COVID-19 exposure (following daily epidemic information, relatives or friends infected). Mental health was assessed using validated Chinese versions of standardized scales: PHQ-9 (Patient Health Questionnaire) for depression, GAD-7 (Generalized Anxiety Disorder 7-item scale) for anxiety, SCL-90 somatization subscale for physical discomfort, ISI (Insomnia Severity Index) for insomnia, and PCL-5 (PTSD Checklist-5) for PTSD. The cutoffs for each scale were pre-defined based on established literature. Data analysis included descriptive statistics (mean, SD, median, IQR), Student’s t-tests, Mann–Whitney U tests, chi-square tests, and multivariable logistic regression to examine the association between pregnancy and mental health outcomes, adjusting for other relevant factors. SPSS version 18.0 was used for statistical analysis.

A total of 859 women participated (544 pregnant, 315 non-pregnant). Pregnant women were more likely to be younger, married, have higher weight and BMI, and employed, while non-pregnant women had higher rates of smoking, drinking, and lower family incomes. Pregnant women had significantly lower median scores on PHQ-9, GAD-7, and PCL-5 compared to non-pregnant women (all p<0.05). There was no significant difference in SCL-90 and ISI scores. The prevalence of depressive symptoms was 5.3% in pregnant women and 17.5% in non-pregnant women (p<0.05). Anxiety symptoms were present in 6.8% of pregnant women and 17.5% of non-pregnant women (p<0.05). Insomnia was reported by 2.6% of pregnant women and 5.4% of non-pregnant women (p<0.05). PTSD was present in 0.9% of pregnant women and 5.7% of non-pregnant women (p<0.05). There was no significant difference in somatic symptoms between the groups. Multivariable logistic regression analysis, adjusting for age, marital status, weight, BMI, employment, smoking, drinking, annual family income, and chronic diseases, showed that pregnancy was significantly associated with a reduced risk of depression (OR=0.23, 95% CI: 0.12-0.45, p<0.001), anxiety (OR=0.26, 95% CI: 0.16-0.42, p<0.001), insomnia (OR=0.19, 95% CI: 0.06-0.58, p=0.003), and PTSD (OR=0.15, 95% CI: 0.04-0.53, p=0.003).

This study provides the first direct comparison of psychiatric symptoms between pregnant and non-pregnant women during the COVID-19 pandemic in China. The findings that pregnant women exhibited lower rates of depression, anxiety, insomnia, and PTSD are noteworthy. These lower rates, however, are likely not reflective of a true protective effect of pregnancy against COVID-19-related mental health challenges, but rather reflect underlying differences in the populations and time of data collection. Differences from other studies on SARS and early COVID-19 data may be attributed to differences in study populations (healthcare workers vs. general population), study timing (early pandemic vs. later phases), and the severity of the disease. The lower prevalence of mental health issues in pregnant women compared to non-pregnant women might be explained by several factors: pre-existing better mental health and financial stability before pregnancy, increased family support during the pandemic, regular contact with medical staff, and possible hormonal influences. While some previous research has shown similar levels of stress or even higher anxiety rates in pregnant women, this study suggests a possible protective effect during the later phase of a pandemic, when governmental interventions may have had a positive impact on overall mental well-being.

This study demonstrated lower prevalence of depression, anxiety, insomnia, and PTSD in pregnant women compared to non-pregnant women during a later phase of the COVID-19 pandemic in China. While several factors could account for this observation, it is crucial to acknowledge potential selection bias in the study sample. Future studies should investigate the role of pre-existing mental health, social support networks, and hormonal changes in influencing mental health outcomes during pandemics. Longitudinal studies tracking pregnant women before, during, and after pandemics would provide a more comprehensive understanding of the interplay between pregnancy, societal stress, and mental health.

The cross-sectional design limits causal inferences. The reliance on online surveys may introduce selection bias, as participation was voluntary and might not be representative of all pregnant and non-pregnant women. The study primarily focused on a population in and around Beijing; findings may not be generalizable to other regions or cultures. The use of self-report measures relies on participant honesty and accuracy in reporting their symptoms.