key: cord-0924714-q5h78bih
authors: Saccone, Gabriele; Florio, Alessia; Aiello, Federica; Venturella, Roberta; De Angelis, Maria Chiara; Locci, Mariavittoria; Bifulco, Giuseppe; Zullo, Fulvio; Di Spiezio Sardo, Attilio
title: Psychological Impact of COVID-19 in pregnant women
date: 2020-05-07
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2020.05.003
sha: df3a11baef58300236a23c5775f77f4ca6d51a63
doc_id: 924714
cord_uid: q5h78bih

nan

The COVID-19 outbreak poses significant risk to public health, including mental health. A 35 survey conducted in China showed that 53.8% of the respondents rated the psychological impact 36 of the outbreak as moderate or severe, and 28.8% reported moderate to severe anxiety symptoms 37 and stress levels. 1 During pregnancy, women may experience stress and anxiety associated with 38 potential adverse obstetrical outcomes such as fetal death or fetal abnormalities. Stress and 39 anxiety level may also increase during infectious disease outbreaks. Currently, there is no known 40 information on the psychological impact, the effect on individual's social and/or psychological 41 aspects, and mental health of pregnant women during the COVID-19 epidemic. 42 The aim of this study was to survey pregnant women to evaluate psychological impact, and 43 anxiety during the COVID-19 outbreak. 46 This was a cross-sectional survey study aimed to assess the psychological response of pregnant 47 women during the epidemic of COVID-19. The study was conducted at University of Naples 48 Federico II (Napoli, Italy), from March 15, 2020 to April 1, 2020. Women with singleton 49 pregnancies were eligible to participate in the study regardless of the gestational age.

After a written informed consent was obtained from the eligible participants, women were asked 51 by their counselor to fill out two questionnaires. A combination of validated measures in the 52 questionnaires were used to assess the psychological impact, and anxiety.

The psychological impact of COVID-19 was measured using an Italian version of the Impact of 55 Event Scale-Revised (IES-R). The IES-R is a 22-item self-administered questionnaire composed 56 of three subscales aimed to measure the mean avoidance, intrusion, and hyperarousal. Each item 57 can be scored from 0 to 4. Total score therefore can be ranged from 0 to 88, with higher scores 58 mean higher psychological impact. The total IES-R score was divided into 0-23 (normal), 24-32 59 (mild psychological impact), 33-36 (moderate psychological impact), and >37 (severe were performed with the use of the T-test by assuming equal within-group variances or with the 80 use of the One-way ANOVA. A 2-sided P value less than .05 was considered significant.

Questionnaires scores were also analyzed according to the gestational age at patient's 82 enrollment.

During the study period, 100 women were enrolled for the study. 17 were in the first, 35 in the 85 second, and 48 in the third trimester of pregnancies. None of the enrolled women had history of 86 postpartum depression in a prior pregnancy or of psychiatric disorders.

Overall, the COVID-19 outbreak had a moderate psychological impact on pregnant women with 88 a mean IES-R score of 36.9±10.1. More than half of the respondents (53/100, 53%) rated the 89 psychological impact as severe. Mean score at STAI questionnaire was 45.2±14.6, with an 90 overall incidence of STAI >36 of 68% (68/100). Mean score at VAS for anxiety for COVID-19 91 vertical transmission was 43.0±26.9, with an overall incidence of score >50 of 46% (46/100) 92 ( Table 1) .

Out of the 17 women who were in the first trimester of pregnancy during the COVID-19 94 outbreak, the 52.9% (9/17) opted for cell-free DNA as first-trimester risk assessment, while Psychological impact of the COVID-19 outbreak was much severe in women in the first 102 trimester of pregnancy. Women who were in the first trimester of pregnancy reported 103 significantly higher mean STAI score, higher rate of STAI score >36, higher mean score at VAS 104 for anxiety for COVID-19 vertical transmission, and higher rate of VAS score >50 (Table 2 ).

The aim of this cross-sectional survey study was to evaluate psychological impact and anxiety in 107 pregnant women during the COVID-19 outbreak in Italy using validated questionnaires. 108 The study showed that the COVID-19 outbreak had a moderate-to-severe phycological impact on 109 pregnant women. More than two third of the women also reported anxiety higher than the 110 normal. Almost half of the women (46%) reported high anxiety regarding the vertical 111 transmission of the disease, assessed as VAS for anxiety scored >50. Sensitivity analyses 112 according to gestational age, showed that women in the first trimester of pregnancy during the 113 COVID-19 epidemic, had higher anxiety and much severe phycological impact compared to 114 those in the second or third trimester of pregnancy. 115 We also found that 52.9% of the women who were in the first trimester during the COVID-19 116 outbreak opted for the cell-free DNA as first-trimester risk assessment compared to the 117 combined screening. This quite high rate of non-invasive prenatal testing, may be explained by 118 the fact that first-trimester risk assessment for trisomy 21 with cell-free DNA is associated with 119 better maternal reassurance and less anxiety compared to the standard first-trimester combined 120 screening based on nuchal trasclucency. Out of the 18 women who delivered during the study 121 period, we reported a 16.7% rate of cesarean delivery on maternal request. This rate is 122 significantly higher compared to the 5-10% rate reported in the literature. 5 Notably, anxiety for 123 fetal injury or fetal death, and emotional aspects, are two of main reasons for planned cesarean 124 delivery on maternal request. 6 However, assessment of the rate of cell-free DNA and of mode of 125 delivery was limited to a very small subgroups according to gestational age at the time of study 126 period, and therefore the study was not powered for these two analyses.

Findings from the study were limited by the single center study design, and the small sample 

Immediate psychological 152 responses and associated factors during the initial stage of the 2019 coronavirus disease 153

Psychometric properties of the Impact of Event Scale-156

The development of a six-item short-form of the state scale of 158 the Spielberger State-Trait Anxiety Inventory (STAI)

Psychometric evaluation of a 161 visual analog scale for the assessment of anxiety

Estimating the rate of cesarean section by 164 maternal request: anonymous survey of obstetricians in Australia

Reasons for elective 167 cesarean section on maternal request: a systematic review