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\begin{document}

\title{Maternal Fear of COVID-19 and prevalence of postnatal depression
symptoms: Risk and protective factors}



\author[1]{Hadar Gluska}%
\author[2]{Noga Shiffman}%
\author[3]{Yael Mayer}%
\author[2]{Lior Elyasyan}%
\author[4]{Nofar Elia}%
\author[1]{Rawan Daher}%
\author[1]{Maya Sharon-Weiner}%
\author[4]{Hadas Miremberg}%
\author[4]{Michal Kovo}%
\author[1]{Tal Biron-Shental}%
\author[2]{Rinat Gabbay-Benziv}%
\affil[1]{Meir Medical Center}%
\affil[2]{Hillel Yaffe Medical Center}%
\affil[3]{The University of British Columbia Faculty of Medicine}%
\affil[4]{Edith Wolfson Medical Center}%


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  \date{May 26, 2024}


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\begin{abstract}
Objective: To evaluate the relations between Fear of COVID-19 and
postpartum depression (PPD) symptoms. Design: A multicenter prospective
observational study. Setting and Population: A cohort of women who
delivered during COVID-19 pandemic between 03-05/2020. Methods:
Participants were virtually approached after delivery and asked to
complete an online questionnaire. Data was verified with each center's
perinatal database. The validated Fear of COVID-19 Scale was in use. PPD
was evaluated using the EPDS questionnaire as a categorical ([?]10) and as
a continuous scale. Pre-existing maternal disability was defined as any
prior physiological/psychological chronic health condition.
Stress-contributing complications during pregnancy or at birth included
pregnancy and labor related complications. Regression analysis and ROC
statistics were utilized to evaluate associations and control for
confounders. Main Outcome Measure: PPD symptoms. Results: Overall, 421
women completed the questionnaires. Of them, 99(23.5\%) had a high EPDS
score. Fear of COVID-19 was positively correlated with PPD symptoms
(r=0.35,p=0.000),ROC-AUC 0.67, 95\%CI 0.61-0.74. Following adjustment to
confounders (maternal age, nulliparity, ethnicity, marital status,
financial difficulties, maternal disability, accessibility to medical
services, and stress-contributing complications during pregnancy (, the
most important factor that correlated with depression was maternal
disability (aOR3,95\%CI 1.3-6.9) followed by Fear of COVID-19
(aOR1.1,95\%CI 1.05-1.15). High accessibility to medical services
(aOR0.59,95\% CI 0.45-0.77) and stress-contributing complications during
pregnancy (aOR0.2, 95\% CI 0.11-0.82) were both protective for PPD
symptoms. Conclusions: During the COVID-19 pandemic, maternal disability
and Fear of COVID-19 are positively associated with a high EPDS score.
High medical accessibility was found as a protective factor for PPD.%
\end{abstract}%



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