key: cord-0883561-34p6xrb6 authors: Folch Ayora, Ana; Salas‐Medina, Pablo; Collado‐Boira, Eladio; Ropero‐Padilla, Carmen; Rodriguez‐Arrastia, Miguel; Bernat‐Adell, María Desamparados title: Pregnancy during the COVID‐19 pandemic: A cross‐sectional observational descriptive study date: 2021-08-17 journal: Nurs Open DOI: 10.1002/nop2.1014 sha: 891869640f6382d36a8debcf3c951148bdee8482 doc_id: 883561 cord_uid: 34p6xrb6 AIM: To provide data on the fears of pregnant women during the confinement period and to learn about the factors, which may have exacerbated fear in Spanish pregnant women during the pandemic. DESIGN: A cross‐sectional observational and descriptive study. METHODS: An anonymous survey was carried out using virtual media in a pregnant population (aged ≥18 years) during the confinement period from 1 April to 1 May 2020. RESULTS: The total sample comprised of 62 individuals, with a mean age of 33.6 ± 3.6 years and a mean gestation time of 23.6 ± 9.8 weeks. All of the women used preventive measures against SARS‐CoV‐2. The most common preventive measures were social isolation (82.3%, n = 51) and frequent handwashing (69.4%, n = 43). The most common feeling was fear (29%, n = 18). The main fears were related to transplacental infection (27%, n = 16), loneliness during childbirth, and being separated from the newborn (27%, n = 16). In addition, 59.7% (n = 37) considered changing their child‐rearing practices after the pandemic. In this sense, pregnant women are one of the most vulnerable subgroups, as their natural physiological changes and mechanisms increase their risk of infection (Dashraath et al., 2020) . In the context of a COVID-19 pandemic, the uncertainty during pregnancy and the risk of vertical transmission in newborns forced prenatal care to be modified. For example, childbirth preparation classes were halted, as were physical medical visits and attendance at basic tests such as analytics or ultrasounds, in favour of new online-based classes (Iorga et al., 2021) . All of these changes and others have had a statistically significant impact on women of reproductive age (Xiong et al., 2020) , particularly pregnant women (Preis et al., 2020) , increasing stress, anxiety, depression and sleep problems (Túlio De-Mello et al., 2020) . Although pregnancy in a pandemic-free context is already stressful, with high levels of anxiety and depression in some cases (Yirmiya et al., 2021) , the mental health of pregnant women has become critical not only for their own well-being but also for the well-being of their child and family (Kinser et al., 2021) . High levels of maternal stress during pregnancy have been shown to increase the risk of preterm birth and intrauterine growth restrictions (Kirchengast & Hartmann, 2021) ; therefore, knowing the fears that pregnant women experienced during the first months of the pandemic would be of great interest in attempting to ameliorate them and designing strategies for mitigating their impact. Cross-sectional observational and descriptive study, with sample collection using an anonymous survey with online and virtual media. Dissemination of the questionnaire began on 1 April 2020 and ended on 1 May 2020. Inclusion criteria: The included participants were pregnant women over 18 years of age who received the questionnaire online through one of the dissemination platforms (social networks) and who voluntarily agreed to complete the survey. Exclusion criteria: Subjects who did not authorize the use of the data for scientific purposes, those aged under 18 years and those who failed to complete any item of the questionnaire were excluded. Non-probability convenience sampling was used. No sample size was established, and all those subjects who voluntarily wished to complete the questionnaire after accepting the use of their data were included. No financial compensation was provided for completing the questionnaire. Whether or not the subjects had been infected with COVID-19 was not taken into account. An ad hoc questionnaire was developed for data collection and sent digitally (Qualtrics ® corporate software), with the objective of improving dissemination and data privacy. The questionnaire consisted of the following variables: • Sociodemographic variables: age, age range (20 to 30 years, 30 to 40 years and >40 years). • Pregnancy-related variables: first pregnancy (yes/no), number of pregnancies (numerical identification of the number of pregnancies), week of gestation (numerical identification of the week of gestation), type of gestation (single/twin). • Childbirth-related variables: preferred type of birth (vaginal/caesarean section), preferred birth partner (free text), preferred type of pain relief (free text). • Variables related to preventive measures against COVID-19: use of measures (yes/no), type of measures (free text). • Variables related to feelings: how the individual felt about living through the pandemic while being pregnant (free text). Classification of positive feelings in terms of the following expressions: feeling well, calm, and bored. Classification of negative feelings in terms of the following expressions: feeling overwhelmed, anxious, afraid, tired, strange, powerless, fearful, nervous, worried, mediocre, lonely, sad. • Fear-related variables: Fears while being pregnant during the pandemic (free text). • Variables relating to raising the baby after living through the COVID-19 pandemic (free text). The electronic survey "Pregnancy in times of COVID-19" was designed by a multidisciplinary group of scientists from Jaume I University. Following a structured review of the literature, a draft survey was created, which was reviewed and edited by the researchers of the project. The questionnaire was prepared using the Qualtrics ® application, with a score of Fairly Good obtained using the ExpertReview analyzer powered by iQ ® . After reaching a consensus with respect to the final version, the survey was shared using WhatsApp TM . The people who received the survey also participated in sharing through the link provided. The survey was structured into two blocks. The first block contained information about the study, its objectives, the research team, ethical information and acceptance of inclusion in the study. The second block contained all the questions relating to the research. The responses to the free-text questions were categorized based on the most commonly reported responses (response patterns). Two members of the research team assigned each response to each of the established patterns, with a consensus on the assignments. In the event of a discrepancy, a third researcher was consulted. The statistical analyses were performed using IBM SPSS Statistics version 26 (IBM Corporation). The continuous variables were described using means ±standard deviation. The categorical variables were expressed using the frequency (n) and percentages (%). The influence of age on the dichotomous qualitative variables of the questionnaire was analysed using the Student's t test for quantitative independent samples. Fisher's exact test was used for qualitative variables as they did not meet normality criteria. Statistical significance was set at p <.05. Using the Qualtrics ® computer application the anonymity of the participants and the confidentiality of the data were guaranteed. The data were not accessible to individuals outside the study. All the study participants responded to the first question of the questionnaire (relating to presentation of the research team, the objectives, and the ethical principles upon which data processing was based), thus leaving a written record of their acceptance or rejection. The subjects who accepted began completing the questionnaire and were able to stop at any time, with data being collected up until that point. A total of 89 people followed the link provided. After presentation of the study, n = 27 agreed to participate but did not respond to all of the questions. Finally, N = 62 pregnant women agreed to participate and responded to all of the questions. The mean age was 33.6 years, with a standard deviation of 3.6. The youngest individual was 26 years of age and the oldest was 44 years old. By age ranges, 16.1% (n = 10) were between 20 and 30 years old, 77.4% (n = 48) were between 30 and 40 years old and 6.5% (n = 4) were aged over 40. The mean number of previous pregnancies was 1.8. The mean length of gestation was 23.6 weeks and 98.3% were single pregnancies (see Table 1 ). All of the women in this study preferred a vaginal birth. Most (93.5%, n = 58) wished to be accompanied by their partner and favoured pharmacological pain relief measures such as epidurals (67.7%, n = 42) (see Table 1 ). All of the surveyed pregnant women used measures against COVID-19 infection. The most common measures were social isolation (82.3%, n = 51), frequent handwashing (69.4%, n = 43), and use of masks (50%, n = 31) (see Table 2 ). The most commonly described feelings were fear (33.9%, n = 21) and of being overwhelmed (25.9%, n = 16) (see Table 3 ). Overall, 95.2% (n = 59) presented with some type of fear, particu- Week of gestation 23.6 ± 9.8 (6-40) were no differences between mothers with more than one pregnancy and primigravid women (see Table 3 ). Overall, 59.7% (n = 37) of the future mothers considered making changes in the upbringing of their baby after the outbreak of the pandemic. The primary changes were restriction of visits (76.5%, n = 26) and reconsideration of breastfeeding after having initially ruled out the opportunity (17.6%, n = 6) (see Table 2 ). The specific fears were not related to any sociodemographic variables or aspects related to pregnancy, childbirth, preventive measures against COVID-19, feelings or changes in parenting (see Table 4 ). The presence of the greatest number of positive feelings was related (p =.022) to pain relief preferences, where the more positive pregnant women opted for non-pharmacological approaches to the palliation of labour pain (50.0%, n = 6). The more negative pregnant women opted for pharmacological treatments for pain relief (74.0%, n = 37). The pregnant women with more positive feelings presented fewer fears (16.6%, n = 2) compared to those with more negative feelings (2.0%, n = 1). None of the other aspects were related to positive or negative feelings (see Table 5 ). The aim of this study was to know about the fears that pregnant women experienced during the first months of the pandemic. Fear TA B L E 4 (Continued) (Salma, 2021) , can result in levels of fear and anxiety not being reduced as the due date approaches, as found in studies prior to the pandemic (Hildingsson et al., 2017) . Furthermore, of note are behavioural changes such as the reconsideration of breastfeeding due to its beneficial effects on the development of the newborn´s immune system (Andreas et al., 2015) . The pandemic and confinement were thus the sole factors responsible for increased feelings of loneliness and fear of infection in pregnant women. Factors such as youth (Berthelot et al., 2020) , inexperience (Hildingsson et al., 2017) and length of pregnancy (Newham et al., 2012) did not condition these fears, as found in research prior to the pandemic and confinement (Berthelot et al., 2020) guidance during pregnancy, and follow-up of pregnant women by telephone Coşkuner Potur et al., 2017; Lucas & Bamber, 2021 The authors would like to thank all pregnant women who participated in this study for their availability and wiliness to share their experiences. No conflict of interest has been declared by the authors. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. 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