Interpretation:
Covid-19 firstly identified and became epidemic in China and has
resulted in an ongoing pandemic.16,17 The increasing
numbers of death tolls, caused global fear and panic. After the first
case of Covid-19, detected in Turkey, Turkish government rapidly carried
out interventions and restrictions to prevent the spread of the
virüs.18 05 May, the date of the beginning of our
study, Turkish ministry of health announced that, total coronavirus
cases in Turkey was 129,491.19 Our study was conducted
after the start of restrictions in Turkey when the psychological and
behavioral changes of the subjects were fully settled. A similar
situation had been shown in a study, conducted in 2003 SARS outbreak in
Hong Kong; with the rising in the number of cases, the level of anxiety
scores also increased. The anxiety scores were highest approximately 1
month after the first SARS case was announced. Women between the 30–49
ages and less educated were more concerned. Anxiety scores of those who
perceived that they were more likely to contract or die due to SARS were
significantly higher.20
Perinatal anxiety is quite common and deserves clinical attention.
According to a meta analyze published in 2017, which included 102
studies with total of 221,974 women, the over all prevalence for any
anxiety disorder was 15.2%.21 Antenatal anxiety was
associated with increased risks for preterm birth, low birth weight,
earlier gestational age, and being small for gestational age, smaller
head circumference.9 Also developmental
delay22, especially the development of brain structure
and function disorders in children are associated with prenatal anxiety
and depression.7,23-26 While we know widely about
perinatal anxiety, there is a limited knowledge about psychological
responses caused by a pandemic. A multi-center cross-sectional study was
initiated in China to compare the mental status of pregnant women before
and after the announcement of the Covid-19 epidemic. A total of 4124
pregnant women during their third trimester were examined in this
cross-sectional study, using the Edinburgh Postnatal Depression Scale
(EPDS). They found that, awareness
of Covid-19 epidemic significantly increased the prevalence of
depressive symptoms (EPDS≥10) (aRR=1.20, 95% CI: 1.04, 1.40, 245
P=0.01) and the risk of self-harm thoughts (aRR=2.85, 95% CI: 1.70,
8.85, P=0.005). A linear positive association was also noted between
EPDS scores and the number of new infections confirmed
daily.27Gillian
A. Corbett, et al. questioned total of 71 patients in the second and
third trimester of pregnancy. Half of the women who did not have anxiety
before, worried about their health during the delay phase of outbreak.
This anxiety was related to health of their older relatives’, other
children they had and then their unborn baby. 28
The previous researches, compared pregnant womens’ anxiety levels with
before and after pandemic, not with non pregnant women, our cohort
showed that pregnant women are vulnerable and they feel fear deeper.
Interaction with their relatives (mother, father, friends), provides
psychological support, but the necessity of social distanding did not
allow this. From Calgary, Canada, 92.9% of 1987 individuals reported
feeling loneliness more than usual due to the Covid-19 pandemic. 56.6%
of participants had clinically elevated anxiety and 37.0% elevated
symptoms of depression. Most of the participants expressed worries about
their own life and their unborn baby due to the possibilty of infection.
Researchers recorded that depression and anxiety symptoms were reduced
if participants could complete enough sleep time and had better social
support.7
According to a preliminary study from Turkey, mean BDI (Back Depression
Index) scores, and mean BAI (The Beck Anxiety Inventory) scores were
greater in the pregnant women. They interpreted that, in the absence of
psychosocial support, adverse perinatal outcomes could
occur.29 However, Mirzadeh and Khedmat also
highlighted the need for psychological support for pregnant women during
this pandemic30, in our study 62% of participants
reported that they get adequate support, but it did not make difference
on their anxiety levels.
During the course of pregnancy, maternal anxiety varies, Haddad et
al.31, Teixeira et al.32 and
Bhagwanani et al.33 reported that STAI-S levels were
increased in the first and third trimester. Other studies have reported
that STAI-S scores elevated significantly in the third
trimester.15,34 The anxiety level differences between
trimesters were not evaluated in an outbreak period, we found that,
there was no difference of STAI-S and STAI-T levels
between trimesters.
Wearing masks, gloves, and washing hands have became daily life
necessities for protection from the virüs. These attitudes were
experienced before, in 2003, during SARS outbreak, about 70% of women
wore a mask all or most of the times, and 40% washed their hands much
more frequently than before.35 Self isolation and ‘not
leaving home’ is another reaction to Covid-19 pandemic in pregnant
women.28 Furthermore, domestic transportation
registrations and the intensity of Covid-19 patients in hospitals,
caused the pregnant women to avoid going to their prenatal visits. It
was reported former SARS outbreak, the rate of cancelling or
postponement of antenatal visits were high and about half of the women
decided delivering in hospitals with fewer SARS
cases.35 The fear of going to hospital was obviously
high in our study and half of pregnants stated that they cancelled or
missed their prenatal visits. In the course of pandemic time, it is
reported that, cancelling of appointments, difficulties in accessing
health units, or going to physicians without a supporter caused poor
quality of prenatal care.7