Prenatal Stress and Psychiatric Symptoms During Early Phases of the COVID-19 Pandemic in Italy

Figures & data

Table 1 Total Sample (N=258). Distributions by 2020 Pandemic Phase in Italy, Pregnancy Period and Pregnancy Risk Status

		Pandemic
Trimester	Risk	1st Phase	2nd Phase	Total
Early (i/ii)	Low-risk	51	54	105
	High-risk	22	20	42
	All	73	74	147
Late (iii)	Low-risk	32	37	69
	High-risk	15	27	42
	All	47	64	111
All	Low-risk	83	91	174
	High-risk	37	47	84
	All	120	138	258

Notes: 1st phase, Pandemic, first phase (April-May 2020); 2nd phase, Pandemic, second pandemic phase (July-August 2020); Early (i/ii), First and second trimester of pregnancy; Late (iii), Third trimester of pregnancy; High-risk, high-risk pregnancy; Low-risk, low-risk pregnancy.

Table 2 Total Sample (N=258). Sociodemographic and Clinical Description. Continuous Measures are Reported in Part A. Binary Measures are Reported in Part B

Part A. Continuous Measures [Range]	N. Patients (%)	Mean ±SD
Age in years [18–46]	255 (98.8%)	32.5 ±5.12
Schooling in years[3–24]	226 (87.6%)	15.1 ±3.60
Level of stress [1–5]	250 (96.9%)	2.3 ±0.98
Level of support from family and friends [1–5]	246 (95.3%)	4.1 ±1.16
Level of support from partner [1–5]	252 (97.7%)	4.5 ±0.88
Level of healthy activities[1–5]	252 (97.7%)	3.7 ±0.93
Knowledge about Covid-19 [1–5]	249 (96.5%)	3.3 ±1.01
Number of children [0–5]	249 (96.5%)	0.6 ±0.79
GAD-7 [0–21]	242 (93.8%)	5.9 ±4.20
PHQ-2 [0–6]	248 (96.1%)	1.0 ±1.20
NuPDQ [0–34]	244 (94.6%)	11.4 ±5.00
PREPS-PS [1–5]	243 (94.2%)	2.9 ±0.86
PREPS-PIS [1–5]	245 (95.0%)	2.6 ±1.02
PREPS-PA [1–5]	245 (95.0%)	2.2 ±1.06
Part B. Binary measures		Count (%)
Currently working	254 (98.4%)	187 (73.6%)
Low financial status	245 (95.0%)	34 (13.9%)
Medium financial status	245 (95.0%)	202 (82.4%)
High financial status	245 (95.0%)	9 (3.7%)
Loss of income due to pandemic	246 (95.3%)	77 (31.3%)
Chronic medical condition	254 (98.4%)	44 (17.3%)
Emotional/Physical abuse	252 (97.7%)	4 (1.6%)
History of Emotional/Psychiatric problems	251 (97.3%)	9 (3.6%)
Lives alone	251 (97.3%)	11 (4.4%)
High anxiety (GAD-7>6)	242 (93.8%)	79 (32.6%)
High depression (PHQ-2>2)	248 (96.1%)	12 (4.8%)
Positive screening for OCD	249 (96.5%)	28 (11.2%)

Abbreviations: GAD-7, General Anxiety Disorder – 7; NuPDQ, Revised Prenatal Distress Questionnaire; OCD, Obsessive-Compulsive problems; PA, PREPS, Positive Appraisal scale; PHQ-2, Patient Health Questionnaire – 2; PIS, PREPS, Perinatal Infection Stress scale; PREPS, Pandemic-Related Pregnancy Stress questionnaire; PS, PREPS, Preparedness Stress scale; SD, standard deviation.

Table 3 Multiple Linear Regressions with GAD-7 Scores and PHQ-2 Scores as Dependent Variables. Standardized Data and Coefficients are Reported with Their 95% Confidence Interval. See Table S1 and S2 for Details

Measure	GAD-7	PHQ-2
	β ±95% CI	β ±95% CI
Intercept	+4.324 [−1.186, +9.834]	+1.966* [+0.406, +3.526]
PREPS-PA	−0.032 [−0.565, +0.502]	+0.052 [−0.101, +0.204]
At-risk pregnancy	+0.865 [−0.281, +2.011]	+0.002 [−0.326, +0.330]
Late pregnancy (3rd trimester)	−0.098 [−1.161, +0.964]	+0.158 [−0.146, +0.461]
1st child	+0.019 [−1.063, +1.101]	−0.101 [−0.413, +0.210]
2nd pandemic phase	+0.292 [−0.788, +1.372]	−0.095 [−0.403, +0.213]
Knowledge about COVID-19	+0.698* [+0.154, +1.242]^§	+0.167* [+0.011, +0.324]^§
Rescheduled prenatal care appointment	−0.219 [−1.600, +1.161]	−0.185 [−0.582, +0.212]
Age (years)	+0.038 [−0.076, +0.152]	−0.008 [−0.040, +0.025]
Schooling (years)	+0.052 [−0.113, +0.218]	+0.001 [−0.046, +0.049]
Not employed	+0.469 [−0.857, +1.796]	+0.417* [+0.039, +0.794]^§
Low financial status	−0.309 [−1.869, +1.252]	−0.197 [−0.647, +0.253]
Loss of income due to pandemic	+0.059 [−1.077, +1.196]	+0.162 [−0.163, +0.487]
History of emotional/psychiatric problem	+6.923* [+4.075, +9.771]^§	+1.479* [+0.652, +2.306]^§
Emotional/Physical abuse	−0.130 [−4.360, +4.100]	−0.182 [−1.411, +1.046]
Chronic medical condition	−0.871 [−2.303, +0.560]	−0.294 [−0.708, +0.121]^§
Level support from family/friends	−0.309 [−0.788, +0.171]	−0.044 [−0.180, +0.093]
Level support from partner	+0.330 [−0.314, +0.974]	−0.067 [−0.246, +0.112]
Level healthy activities	−0.958* [−1.529, −0.386]^§	−0.268* [−0.434, −0.103]^§
Lives alone	+3.015* [+0.404, +5.626]^§	+0.392 [−0.366, +1.150]

Notes: *Statistically significant with p<0.050. ^§Predictor maintained in the corresponding backward-selected model.

Abbreviations: CI, confidence interval; GAD-7, General Anxiety Disorder, 7-items, questionnaire; PHQ-2, Patient Health Questionnaire, 2-items, questionnaire; PREPS-PA, Pandemic-Related Pregnancy Stress questionnaire, Positive Appraisal scale.

Figure 1 Mediations of pregnancy-specific stress (NuPDQ) in regressions of anxiety score (GAD-7) on pandemic-related stress measures (PREPS-PS and PREPS-PIS). Mediation coefficients are reported with 95% confidence interval between square brackets. Selected covariates are listed. See Tables S1 and S4 for details.

Abbreviations: ADE, Average Direct Effect; GAD-7, General Anxiety Disorder, 7-items, questionnaire; NuPDQ, Revised Prenatal Distress Questionnaire; PIS, Prenatal Infection Stress scale; PREPS, Pandemic-Related Pregnancy Stress Scale; PS, Preparedness Stress scale; X, Arrow not statistically significant after mediation.

Figure 2 Mediations of pregnancy-specific stress (NuPDQ) in regressions of depression score (PHQ-2) on pandemic-related stress measures (PREPS-PS and PREPS-PIS). Mediation coefficients are reported with 95% confidence interval between square brackets. Selected covariates are listed. See Tables S2 and S4 for details.

Abbreviations: ADE, Average Direct Effect; NuPDQ, Revised Prenatal Distress Questionnaire; PHQ-2, Patient Health Questionnaire, 2-items; PIS, Prenatal Infection Stress scale; PREPS, Pandemic-Related Pregnancy Stress Scale; PS, Preparedness Stress scale; X, arrow not statistically significant after mediation.

Figure 3 Mediations of pregnancy-specific stress (NuPDQ) in regressions of screening for obsessive-compulsive problems on stress for prenatal infection (PREPS-PIS). Mediation coefficients are reported with 95% confidence interval between square brackets.

Abbreviations: ADE, Average Direct Effect; NuPDQ, Revised Prenatal Distress Questionnaire; OCD, positive screening for Obsessive-Compulsive Disorder; PIS, Prenatal Infection Stress scale; PREPS, Pandemic-Related Pregnancy Stress Scale; X, Arrow not statistically significant after mediation.