Main findings
We report the first large cross-sectional study of pregnant women on
their anxiety status and obstetrical choices during the outbreak of
COVID-19. We focused on the epicenter (Wuhan) and a neighboring city
(Chongqing), involving 932 and 1015 participants, respectively.
Previous studies indicate that the global estimated prevalence of
anxiety during pregnancy fluctuates at about 14%-24%28,29, and this prevalence was about 15.04% in
China.30 Unfortunately, during the study period, the
anxiety rate was 17.16% generally, with a much higher rate in Wuhan
(24.47%) but within the expected range in Chongqing (10.44%). Such a
difference was probably due to the highest exposure and the strictest
restrictions in Wuhan. We found out that being the epidemic center had
major impact on anxiety, along with household income and important
attitudes towards COVID-19 (e.g. outdoor activities). Though previous
studies found pregnancy characteristics as influence factors of prenatal
anxiety 30-32, these factors have not been identified
through our multivariable analysis, but may be potentially associated
with anxiety given our results of univariable analysis (Table 4S). We
believe that the mechanism of epidemic to anxiety is unique, so regional
differences greatly mask these conventional factors, which further
reminds us to pay attention to prenatal anxiety during a PHE.
Similar to anxiety, obstetrical choices revealed an area-based
difference. Vital choices changed, including the time of prenatal care
or delivery, mode of delivery and child-feeding, etc. Those changes,
without guidance, may lead to irreversible adverse events. Although the
influence factors of obstetrical issues were hard to describe in a short
time (data not shown), our hypothesis (Figure 1) was likely to exist as
some evidence already showed that anxiety could change prenatal
decisions.16,33 A mediation analysis, should be
conducted to better understand the pathway of prenatal anxiety to
obstetrical choices during a PHE, and is a planned step based on the
current data. Here, we hope to get more concern from researchers and
call for relevant suggestions.