Introduction
In late December 2019, China reported a cluster of pneumonia caused by a novel coronavirus (2019-nCoV).1 This pathogen was eventually named SARS-CoV-2 by WHO,2 with its associated disease named COVID-19.3 As of 3 April 2020, 81,620 cases of infection have been confirmed in China, especially in Hubei Province (N=67,802),4 however, SARS-CoV-2 has spread to at least 151 countries/territories/areas with over 800,000 cases outside of China,5 leading to the successive WHO announcements of ”public enemy number one” and ”a very high level of global risk”.6,7
The rapid transmission and life-threatening characteristics of COVID-19 have been reported transparently in China currently. The public, influenced by both accurate and erroneous news, are stressed.8 All provinces in mainland China with confirmed cases of COVID-19 have adopted the first-level PHE responses, including travel bans and executive orders on daily life.9 Consequently, the Chinese New Year holiday was seriously disrupted and public anxiety was aggravated about life-convenience and established arrangements.
Pregnant women, as a vulnerable population,10 may be of a particular concern, as anxiety itself has already been documented as a common psychological problem during pregnancy.11Recently, the discussion on COVID-19 complicated pregnancy mainly focused on the therapeutic aspect 12-14 while little is known regarding their mental status and psychological needs during the epidemic.
Prenatal care is vital to a healthy pregnancy.15Recently, the emergency traffic bans have made some medical resources inaccessible and the anxiety may deter women to attend routine prenatal care,16 all of which could eventually threaten pregnancy outcomes. Of particular importance are ectopic pregnancy, first-trimester spontaneous abortion, delayed detection of fetal congenital anomalies, uncontrolled hypertension and preeclampsia (which may develop into heart failure), post-term delivery and dystocia.17-19 These obstetrical adverse events may have more devastating consequences than COVID-19 infection itself.8,20,21 Certainly, professional advice on choosing obstetrical care was desired 22, but we know little about women’s decisions during the COVID-19 and other PHEs.
We conducted a survey in pregnant women in Wuhan (the hardest-hit area) and Chongqing (a neighboring city) during the COVID-19 outbreak, to investigate anxiety status and its influence factors, to demonstrate and explain the vital prenatal choices, and finally to guide social and medical practice.