To the Editor,
According Khamees et al. study [1] entitled “Anxiety and depression during pregnancy in the era of COVID-19” that was published in June 2021 in your valuable journal, we wanted to share our experience of the fear and anxiety of the pregnant women of being infected by COVID-19 in themselves and their newborns. This study was performed in Sistan, a very deprived area in Iran where the Delta has caused many deaths because its high infection ability and transferability [2].
One of the high risk groups for COVID-19 infection is pregnant women and psychological well-being of these women is important. Findings of previous studies during severe acute respiratory syndrome (SARS) outbreak in 2003 showed that they experienced high levels of anxiety and worries [3, 4] which could affect maternal and fetus well-being. Preterm delivery, low birth weight and caesarean deliveries are consequence of prenatal stress [5, 6].
In this study pregnant women were asked to fill the valid and reliable Persian version of Beck Anxiety Inventory (BAI) [7]. BAI included 21 questions, each had multi-choice responses and scoring between 0 and 3. Scores between 0 and 7 showed no anxiety, scores between 8 and 15 showed mild and scores between 16 and 25 were indicatives of moderate anxiety and scores more than 26 showing severe anxiety. Data regarding age, gestational age, knowledge regarding routes of transmission, prevention methods, conduction diagnostic tests, symptoms during the pandemic stage, following quarantine rules, and if one of the relatives had COVID-19.
One hundred and 49 pregnant women participated in this study. The mean ± SD (standard deviation) age and gestational age were 27.6 ± 6.2 years and 21.2 ± 10 weeks respectively. The mean ± SD of BAI score was 10.1 ± 7.4 which indicated mild anxiety. Basic characteristics of the participants as well as the complications and their anxiety levels are shown in Table 1.
Basic characteristics, the complications and the anxiety levels of the participants.
| Variables | |
|---|---|
| Age, years (mean ± SD) | 27.6 ± 6.2 |
| Gestational age, weeks (mean ± SD) | 21.2 ± 10 |
| Pregnancy complications | |
| Hypertension, n (%) | 15 (10%) |
| Gestational diabetes, n (%) | 8 (5.3%) |
| Preeclampsia, n (%) | 4 (2.6%) |
| Bleeding, n (%) | 24 (16.1%) |
| Parity (mean ± SD) | 1.9 ± 1.1 |
| Abortion (mean ± SD) | 2.2 ± 1.5 |
| Anxiety level | |
| No anxiety, n (%) | 69 (46.3%) |
| Mild, n (%) | 50 (33.6%) |
| Moderate, n (%) | 26 (17.4%) |
| Severe, n (%) | 4 (2.7%) |
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SD, standard deviation.
The results showed that more than half of pregnant women were anxious and there was no significant difference regarding pregnancy trimester and level of anxiety. We also found that 94% were worried about getting COVID-19 and 97% were worried about their neonate’s infection. In a study which was conducted by Liu et al., 1947 pregnant women were evaluated. They found that near 90% of the participants found themselves vulnerable for this infection and forth-fifth felt nervous [8].
Anxiety status was reported in 24.5% in Wuhan participants and 10.4% in participants of Chongqing [8]. The anxiety was more common in our pregnant women. Except one, all other participants believed that the risk of COVID-19 infection is higher in pregnant women and 86% believed that coronavirus could transmit from mother to the fetus. More than 80% of our cases were anxious during ultrasound examination in this period and 97% were worried if their neonate got coronavirus. Lebel et al. assessed anxiety and depression symptoms among 1987 pregnant women in Canada and reported moderate anxiety in 46% and severe in 10%. Depression symptoms were reported in 37% [9]. In their survey, 89% reported changes in prenatal care and 35% made changes to their birth plan. Like our findings, they found no significant difference regarding anxiety score between nulliparous and multiparous women. Prevalence of anxiety is increased in pregnant women during COVID-19 pandemic while previous surveys demonstrated the prevalence of anxiety in pregnant women between 14 and 24% [10], [11], [12]. Our results also showed that the most common symptoms during pandemic stage were nausea/vomiting followed by cough.
Prenatal anxiety is an issue of concern which should be considered by both patients and physicians which may affect the pregnancy outcome. In this period, social support plays an important role to prevent depression and anxiety during pregnancy [9]. One of the crucial factors of well-being is social support which increases positive feelings and emotions [13]. It seems that during COVID-19 pandemic stage pregnant women need more psychological support.
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Research funding: None declared.
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Author contributions: Z.S: Project development, manuscript writing. A.G: Project development. M.G: Data collection and management, manuscript editing. M.N.M.: Manuscript editing, data management. All authors approved the sub-mitted version (and any substantially modified version that involves the author’s contribution to the study. All authors are agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The local Institutional Review Board deemed the study exempt from review. The study was performed in accordance with Helsinki declaration. All patients’ data were kept confidential.
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Data availability: The datasets used during the current study are available from the corresponding author on reasonable request.
References
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