Stress, anxiety and depression in 1466 pregnant women during and before the COVID-19 pandemic: a Dutch cohort study

Abstract

Objective

The coronavirus disease (COVID-19) pandemic has negatively affected many people’s mental health with increased symptoms of stress, anxiety and depression in the general population. Anxiety and depression can have negative effects on pregnant women and result in poor neonatal outcomes. Therefore, we analyzed stress, anxiety and depression in pregnant women during the COVID-19 pandemic.

Materials and methods

Cohort study of pregnant women during COVID-19 compared to pregnant women before COVID-19. Pregnant women were recruited through social media platforms from 21 May 2020 to 22 June 2020. Pregnant women ≥ 18 years of age, who master the Dutch language were included. The Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS-10) were analyzed. Demographic features were summarized using descriptive statistics. Possible differences in demographic variables between groups were compared using Mann Whitney U test and Chi-squared test. Significant demographic differences between groups were controlled for using logistical regression analysis or an independent one-way analysis of covariance.

Results

Thousand hundred and two pregnant women completed the questionnaires during COVID-19, and 364 pregnant women before COVID-19. We found no differences in clinically high levels of anxiety (HADS-A ≥ 8) and depression (HADS-D ≥ 8) in women during COVID-19 (19.5% and 13.2%, respectively) and women before COVID-19 (23.1% and 15.7%, respectively). A question was implemented whether participants related their stress level to COVID-19. Women who related their stress to the COVID-19 pandemic reported significantly higher overall stress levels on the PSS-10 compared to women with stress unrelated to COVID-19 (mean, 15.62; standard deviation [SD], 6.44 vs. mean, 10.28; SD, 5.48; p < 0.001).

Conclusion

In contrast to previous studies, COVID-19 did not increase anxiety and depression levels in Dutch pregnant women. Women who related their perceived stress to the COVID-19 pandemic experienced higher stress levels than women who did not relate their stress to the COVID-19 pandemic, suggesting that interventions that specifically aim to reduce COVID-19 stress, may help to reduce overall stress levels in pregnant women during the pandemic.

Keywords:

• Pregnancy
• mental health
• stress
• anxiety
• depression
• COVID-19
• SARS-COV-2

Ethical approval

The ethical approval for this study was obtained from Medisch Ethische Toetsingscommissie VUmc on 18 May 2020 (Reference number: 2020.260).

Author contributions

BFPB, RAdL, MGvP and CJMdG contributed to the design of the study. RAdL build the online questionnaire. SJMZ, BFPB, RAdL, MGvP and CJMdG reviewed the questionnaires that were included for this study. SJMZ, BFPB, RAdL, MGvP and CJMdG helped raise awareness for the study through online content and flyers in the hospitals and midwifery practices. YMGAH contributed with the data from the control group and analyses. SJMZ, SVM and YMGAH analyzed and interpreted the data. SVM, BFPB, YMGAH and CJMdG provided background knowledge to the data analysis and interpretation. SJMZ drafted the manuscript. All authors reviewed the manuscript and have seen and approved the final version.

Author agreement

We declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We understand that the corresponding author is the sole contact for the editorial process. They are responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs.

Disclosure statement

The authors have no conflicts of interest to declare.