Study identifies pregnant women at greater risk of PTSD during COVID-19 Pandemic

Pregnancy is a rewarding yet challenging period of life, which demands physical, psychological and social adjustment to a new role. In general, pregnant women are not prone to experiencing higher levels of stress and anxiety in comparison to non-pregnant controls. It has been said that COVID-19 significantly increases the risk of preterm birth (approximately three-fold), mostly due to iatrogenic reasons.

Generally, psychological distress is believed to play an important role in the occurrence of adverse pregnancy outcomes, preterm delivery included. Although the data concerning the psychological effect of the coronavirus pandemic on pregnant women are limited, most studies suggest that it has a moderate to even severe impact.

Interestingly, it was also shown that women in the first trimester are more prone to experiencing high levels of anxiety and emotional distress in comparison to their counterparts in more advanced stages of pregnancy.

Anna Stepowicz and team conducted a study to analyze the degree of stress and anxiety experienced by pregnant and post-partum women during the COVID-19 pandemic published in International Journal of Environmental Research and Public Health.

The following aspects were investigated in terms of their correlation with anxiety and stress levels: age, education, marital status, parity, eventful obstetric history, the history of psychiatric treatment, number of hospital stays during current pregnancy, gestational age/post-partum, the presence of comorbidities, and the time of assessment.

The study was conducted in the Department of Perinatology, Obstetrics and Gynecology, Polish Mother's Memorial Hospital and Research Institute, Lodz, Poland between 7 April and 24 May 2020. Two hundred and ten adult females aged 19 to 45, both pregnant and post-partum subjects, were enrolled. In order to credibly and quantitatively assess stress and anxiety levels, two well-established test-tools were applied: State-Trait Anxiety Inventory (STAI) and Perceived Stress Scale (PSS-10). They are non-invasive, easy and fast to conduct (5–10 min) self-report questionnaires. The PSS-10 assesses the degree to which one appraises their life situation as stressful, unpredictable, uncontrollable, and overloading over the previous month via ten items on a 5-point Likert scale. The results of these tests are presented both in point- and STEN-scores.

In the study group, 164 women were pregnant: 11 in the first trimester (5.2%), 46 in the second trimester (21.9%) and 107 in the third trimester (51.0%), whereas 46 were post-partum (21.9%). The majority of patients enrolled in the study were nulliparous: 112 (46%).The history of previous or ongoing mental treatment, defined as both psychotherapy and/or use of pharmaceuticals, was reported by 29 patients (13.8%).

Results:

• The median score of PSS-10 test among patients was 18 points in a 0–40-point scale and was perceived as a moderate level of stress experienced in the past month.
• The median score of the STAI-trait subscale was 43 points, suggesting moderate anxiety proneness among the study group. The mean score of STAI-state subscale, however, was as high as 45 points and indicated high levels of anxiety defined as current feeling of tension, nervousness, and general worry.
• The results of study reveal a statistically significant correlation between the history of mental treatment and high levels of anxiety in STAI-trait (p = 0.0001): 69% of patients with such history showed high levels of anxiety in comparison to only 29% in the subgroup with no such treatment.
• Similar results were acquired based on PSS-10 : high levels of stress were much more common in patients with mental treatment history (69%) than in those without one
• Moreover, there was a statistically significant correlation between marital status and anxiety levels measured by STAI-state, which showed that anxiety levels in pregnancy are higher in single women and in those in informal relationship compared to married controls.
• The study demonstrated a statistically significant correlation between gestational age and anxiety levels based on STAI-state, but not on STAI-trait or PSS-10.
• In patients in the first trimester, 82% demonstrated high anxiety levels, compared to 74% in the second trimester, and to 54% in the third trimester, and to only 52% in puerperium

Moreover, it was observed that anxiety and emotional distress were higher in patients with mental treatment history than in those without such. The correlation was statistically significant in PSS-10 and STAI-trait scale. STAI-trait shows a general propensity to experience anxiety, rather than current feeling of arousal and distress, which is better demonstrated in STAI-state scale.

Uncertainty and instability that may accompany a single mother are clear and obvious aspects that trigger anxiety and distress. On the contrary, a stable and happy relationship is likely to wake a feeling of calmness, security and predictability. The study showed that married women tend to experience less anxiety than those who are single or in an informal relationship.

The levels of stress and anxiety in pregnant and post-partum women during the COVID-19 pandemic are moderate to high. Anxiety and distress tend to be higher in women with psychiatric treatment history, those in the first trimester of pregnancy, and the ones that are single or in an informal relationship.

The researchers concluded, "Our findings could be applied to identify patients at greater risk of experiencing adverse mental effects and enable us to provide them with adequate psychological support. The power of these conclusions is limited due to the single-center study design and the lack of a control group outside the period of the COVID-19 pandemic."

Source: Anna Stepowicz, Barbara Wencka, Jan Bie ´nkiewicz , Wojciech Horzelski and Mariusz Grzesiak

Int. J. Environ. Res. Public Health 2020, 17, 9450; doi:10.3390/ijerph17249450