Understanding psychological wellbeing in pregnant women in and outside COVID-19 and the importance of including fathers

Since COVID-19 pandemic started more than a year ago, studies have emerged about its effect on the psychological wellbeing of pregnant and postpartum women. Sufficient studies have been published to pool global results. A systematic review in this issue involving 11,187 women showed that the worldwide prevalence of depression and anxiety during pregnancy is estimated 30 and 34%, respectively [1]. In a subset of studies, it was possible to make a comparison between pregnant women before and during COVID-19 pandemic. These studies report that during COVID-19, the prevalence of depression and anxiety doubled.

Although the risk of depression and anxiety seems increased during COVID-19, it still remains unclear which specific factors are causal. One factor might be the lack of appropriate information. A web-based survey in India showed that a significant proportion of people had incorrect information about the impact of COVID-19 during pregnancy and breastfeeding, resulting in mistaken overestimation of the adverse risks of pregnancy and child outcomes [2]. A web-based survey in The Netherlands showed that women who related their experienced stress to COVID-19 had higher levels of stress compared to women who did not relate their stress to COVID-19 [3]. Another study in this issue showed that pregnant women with higher resilience experienced significantly lower psychological distress during COVID-19 [4]. The results of these studies indicate that interventions specifically addressing knowledge, COVID-19 related stress and increasing resilience could improve mental wellbeing during pregnancy.

Irrespective of COVID-19 pandemic, fear of childbirth (FOC) or tocophobia affects 14% of pregnant women worldwide [5]. Although fear of childbirth is quite common, there is still no evidence for the best treatment. This might be hampered by the heterogeneity of co-morbid psychological and psychosocial characteristics. A Turkish study found that demographic and obstetric factors played a limited role in FOC [6]. However, FOC was associated with less self-efficacy and higher trait anxiety. In addition, spousal support was found to be a mediator variable in the relationship between self-efficacy and FOC, showing the importance of support as a buffer against stressful situations such as a delivery. A Swedish study of pregnant women with FOC revealed two clusters: one with strong attitudes and lower fear, labeled “self-determiners”, and one with no strong attitudes but high levels of fear, labeled “fearful” [7]. It seems important to differentiate between the different subtypes of women with FOC to determine which treatment would be most effective.

Fortunately, more attention is being paid to the early detection and treatment of maternal peripartum psychiatric disorders. But how about the fathers? How do fathers deal with pregnancy as a major life event? And what are their specific needs?

A meta-analysis about anxiety among 40,124 fathers during and after pregnancy, showed that the overall estimate of paternal peripartum anxiety was 11% [8]. This is considerably higher than the global WHO prevalence rates for anxiety among men, suggesting that transition to fatherhood may place fathers at greater risk for anxiety [9]. Paternal anxiety and depression were further elaborated in a study focusing on the birth of a preterm baby. This study showed that fathers of preterm babies were significantly more likely to experience anxiety and impaired quality of life compared to fathers with term babies. Therefore, the authors advocate to routinely screen fathers of preterm babies.

Another call for including the fathers comes from Chase et al. who advocate to routinely screen for Couvade syndrome [10]. This long ago described, but still largely unrecognized condition, is explained as a somatic symptom disorder where a partner experiences somatic symptoms during their partner’s pregnancy. Symptoms include anxiety, weight gain, toothache, gastrointestinal disturbance, changes in sleep patterns, decreased libido, and insomnia. Next to psychodynamic explanations associated with the marginalized role and envy of men during pregnancy, there is also evidence for hormonal changes of men during their partner’s pregnancy that could explain Couvade symptoms. This remains an unexplored area where there is still much to be understood.

Disclosure statement

No potential conflict of interest was reported by author(s).