Severity of depressive and anxious symptoms and its association with birth outcomes among pregnant women during the COVID-19 pandemic: a prospective case-control study

Figures & data

Figure 1. A flow chart of study subject recruitment, exclusion and loss of follow-up.

Table 1. Comparison of demographic information and general clinical data of the outbreak group and the pre-outbreak group.

Variables	Outbreak group (N = 783)	Pre-outbreak group (N = 783)	P value
Maternal age (years)(average, SD^a	31.10 (3.96)	30.89 (3.91)	0.848
Type of household registration (value, n, %)^b	Field permanent resident, 354, 45.2%; Local, 359, 45.8%; Field mobile residents, 69, 8.8%; Foreign residents, 1, 0.1%		1.000
Education Level (median, IQR)^c	5 (2)	5 (2)	1.000
Parity (median, IQR)^c	0 (0)	0 (0)	1.000
BMI (value, n, %)^b	BMI ≤ 18.5, 132, 16.9% 18.5< BMI <24, 517, 66.0% BMI ≥ 24, 134, 17.1%	BMI ≤ 18.5, 96, 12.3% 18.5< BMI <24, 566, 72.3% BMI ≥ 24, 121, 15.5%	0.014
Marriage age (years) (average, SD)^a	28.01 (3.57)	27.56 (3.23)	0.010
Marriage duration (years) (average, SD)^a	3.20 (3.73)	3.36 (3.54)	0.370
Husband age (years) (average, SD)^a	32.92 (4.82)	32.64 (4.91)	0.245
Spouse age difference (median, IQR)^c	1 (3)	1 (3)	0.180
Gravidity(average, SD)^a	1.70 (0.97)	1.77 (1.11)	0.190
Gestational age (weeks) (median, IQR)^c	10.43 (3)	10.29 (2.86)	0.056
Husband health (n, %)^b	762 (97.3%)	773 (98.7%)	0.046
Recent history (n, %)^b	1 (0.1%)	3 (0.4%)	0.317
Pregnancy medication history (n, %)^b	70 (8.9%)	71 (9.1%)	0.930
Past medical history (n, %)^b	16 (2.0%)	71 (9.1%)	<0.001
Family history (n, %)^b	83 (10.6%)	36 (4.6%)	<0.001
Toxicants (n, %)^b	41 (5.2%)	50 (6.4%)	0.331
Pregnancy fever (n, %)^b	6 (0.8%)	10 (1.3%)	0.315
Pregnancy risk (n, %)^b	501 (64.0%)	431 (55.0%)	<0.001
Total GAD-7 score (average, SD)^a	2.83 (3.44)	3.00 (3.51)	0.326
Total PHQ-9 score(average, SD)^a	4.51 (3.78)	4.83 (3.91)	0.092

Note: Statistically significant P−values are shown in bold. The significant difference between BMI ≤ 18.5 and 18.5< BMI <24.

^a Statistical analysis was performed by independent sample t test.

^b Statistical analysis was performed by chi-square test.

^c Statistical analysis was performed by Mann-Whitney U test.

IQR: Interquartile-range, BMI: Body-mass index, GAD-7: General Anxiety Disorder-7, PHQ-9: Patient Health Questionnaire.

Figure 2. MGM network with the outbreak group (left) and the pre-outbreak group (right). Green edges indicated positive relationships, red edges indicated negative relationships and grey edges indicated relationships involving categorical variables for which no sign is defined. The width of the edges was proportional to the absolute value of the edge-parameter. The colors of the nodes mapped to the different domains Demographics, Clinical, Anxiety and Depression.Note: 3:Marriage_dur: Marriage duration; 4: hus_age: husband’s age; 5: hus_wife_age_diff: age difference between husband and wife; 6: hus_health: health status of the husband; 9: preg_med: Medicines during pregnancy; 10: past_his: past medical history; 11: family_his: family history; 13:preg_fever: fever in pregnancy; 14:preg_risk: pregnancy risk.

Figure 3. Comorbidity symptoms network of anxiety and depression with the outbreak group (left); bridge centrality index of symptoms network with the outbreak group (right).

Figure 4. Comorbidity symptoms network of anxiety and depression with the pre-outbreak group (left); bridge centrality index of symptoms network with the pre-outbreak group (right).

Figure 5. Centrality index of comorbidity symptoms network of anxiety and depression (red: outbreak group; blue: pre-outbreak group).

Figure 6. Stability analysis results for expected influence and bridge expected influence in the outbreak group (left) and pre-outbreak group (right). Lines indicate the means and areas indicate the range from the 2.5th quantile to the 97.5th quantile.

Table 2. Logistic regression results for the levels of depressive and anxious symptoms on gestational and neonatal outcomes for the outbreak group and the pre-outbreak group.

Symptoms	Outbreak group (N = 618)	Pre-outbreak group (N = 659)
GAD2 (Uncontrollable worry)	↑ PROM (B = 0.67, OR (95% CI) = 1.96 (1.20, 3.19), p = 0.007) ↓ HDCP (B = −0.73, OR (95% CI) = 0.48 (0.25, 0.92), p = 0.028)
GAD3 (Generalized worry)	↑ Neonatal respiratory disorders (B = 1.16, OR (95% CI) = 3.19 (1.12, 9.10), p = 0.030)
GAD4 (Trouble relaxing)	↓ PROM (B = −0.91, OR (95% CI) = 0.40 (0.21, 0.77), p = 0.006)	↑ PROM (B = 0.50, OR (95% CI) = 1.65 (1.02, 2.69), p = 0.042)
GAD5 (Restlessness)		↑ PTB (B = 1.33, OR (95% CI) = 3.80 (1.45, 9.90), p = 0.006) ↑ Neonatal respiratory disorders (B = 1.31, OR (95% CI) = 3.71 (1.58, 8.68), p = 0.003)
GAD6 (Irritability)		↓ Neonatal hypoglycemia (B = −0.50, OR (95% CI) = 0.60 (0.37, 0.98), p = 0.043) ↑ Hypothyroidism in pregnancy (B = 0.72, OR (95% CI) = 2.05 (1.08, 3.88), p = 0.028)
GAD7 (Fear of awful events)		↑ LBW (B = 1.14, OR (95% CI) = 3.14 (1.11, 8.82), p = 0.030) ↑ Neonatal hypoglycemia (B =1.38, OR (95% CI) = 3.98 (1.61, 9.84), p = 0.003)
PHQ3 (Sleep problems)	↑ PTB (B = 0.78, OR (95% CI) = 2.17 (1.21, 3.90), p = 0.009)
PHQ7 (Trouble concentrating)		↑ Intrapartum fever (B = 0.61, OR (95% CI) = 1.84 (1.08, 3.12), p = 0.024) ↑ PROM (B = 0.40, OR (95% CI) = 1.49 (1.04, 2.13), p = 0.029)

Note: PROM: premature rupture of membrane, HDCP: hypertensive disorder complicating pregnancy, PTB: preterm birth, LBW: low birth weight.

↑ Represents standardized regression coefficient B > 0, odds ratio > 1, p < 0.05; ↓ represents standardized regression coefficient B < 0, odds ratio < 1, p < 0.05.