In this study, we sought to better understand the mental health issues and the COVID-19 related anxiety in pregnant health care workers in Iran. Besides, we assessed the correlation between mental health status using the GHQ-28 score and COVID-19 related anxiety. As we found, the prevalence of moderate to severe psychological problems and COVID-19 related anxiety among pregnant health care workers were 9.4% and 26.5%, respectively. In addition, our results showed a significant correlation between COVID-19 related anxiety and its subclasses, physical and psychological, and GHQ-28 total score and its subclasses, including somatic symptoms, anxiety/insomnia, social dysfunction, and depression. Women comprise the majority of health care workers. Therefore, the high prevalence of mental health issues (both occupational and non-occupational) among health care workers and pregnant women would necessitate conducting a study about mental health issues of pregnant health care workers.
Pregnancy is known to be a phenomenon with various physiological and psychological changes, such as immune system alterations (20). Pregnant women are vulnerable to stress and mental health issues since they have many concerns about the effects of COVID-19 on their pregnancy and labor (14, 21). Although it is unclear whether pregnant women are at higher risk of developing severe COVID-19 and its complications, some studies suggested the probability of vertical transmission of COVID-19 to the fetus (22). In addition, some measures have been implemented that may increase the level of anxiety and psychological stress in pregnant women, including social distancing, minimizing in-person care, prohibiting labor partners for a time, and restricting visitors in postpartum wards (23–25).
According to the guidelines of several western countries, the employer is not allowed to continue employing a pregnant woman unless the risk of COVID-19 infection is equal to the general population. Besides, the pregnant health care workers should not have close physical contact with the COVID-19 patients and work with elective patients who were screened negative for COVID-19 (26, 27). However, in some countries, due to the COVID-19 crisis and the shortage of health care workers and facilities, pregnant health care workers have to work like their non-pregnant peers on the front lines of the fight against COVID-19 (28, 29). This disastrous circumstance would certainly affect their mental health status, as a result.
Sut et al. (30) reported that the prevalence of anxiety and depression was 64.5% and 56.3%, among pregnant women during the COVID-19.
Liu et al showed that health care workers who had close physical contact with COVID-19 patients were more anxious and depressed compared with their counterparts who had no contact. Close contact with COVID-19 patients was also shown to negatively affect the medical staff’s quality of life (31). In contrast, a recent study reported that there was higher prevalence of anxiety among non-medical healthcare workers without direct contact compared to medical personnel who might have direct contact with COVID-19 cases (32). It has been reported that the social support of health care workers was associated with self-efficacy and quality of sleep. However, it had an association with decreased levels of stress and anxiety (33). In the current study, COVID-19 related anxiety and its subclasses, physical and psychological, were significantly correlated with GHQ-28 total score and its subclasses, including somatic symptoms, anxiety/insomnia, social dysfunction, and depression among pregnant health care workers.
The present study has several limitations. One of the limitations is its cross-sectional design. The investigation of causal relationships is impossible with a cross‐sectional design. Another limitation is that participation in the study was voluntary; thus, there was the possibility of selection bias. In addition, the in-person questionnaires seem to be more accurate and reliable than the on-line questionnaires. However, in order to minimize the physical contact, we selected the on-line questionnaires.
The prevalence of anxiety and mental health issues in pregnant health care workers is comparatively high in the COVID-19 era. Based on the results of the current study, it is crucial to pay more attention to the mental health of the pregnant health care workers during COVID-19 pandemic. Rapidly increasing the number of cases, shortage of facilities and medical staff, and not having information about the effects of COVID‐19 on pregnancy and their fetus are the most crucial factors associated with the development of COVID-19 related anxiety and mental health problems in pregnant health care workers.