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.