One of the crucial considerations in times of health crisis is managing stress and anxiety. These elements can be felt differently within a population; thus, pregnant women constitute one of the groups at greatest risk of psychological trauma during crises. The scale of COVID-19 has suddenly plunged the world into an unprecedented scenario of stress and anxiety. Therefore, it remains essential to take care of the mental health of vulnerable people, such as pregnant women because of the double risk involved (mother and fetus).
Results of this study indicate a high level of stress and worry in pregnant women. These findings are similar to those observed in specific contexts [12, 14, 20] and higher than those reported in other contexts [11, 21]; thus confirming our initial hypothesis. The variability of the measurement of stress and anxiety makes our comparison difficult and could only be approximate. Nevertheless, the unpredictable and unprecedented nature of this pandemic largely explains this psychological state in pregnant women in Guinea. The experience of managing the Ebola outbreak has led health authorities to think of the equivalent risk. As a result, we observed a delay in the effective management and the response to stop the spread of the pandemic; the lack of communication on COVID-19, with the effects of instilling doubt, suspicion and fear in the mentality of the population including pregnant women.
We found in this study that residence is associated with stress and worry in pregnant women. These are most affected in the municipality of Ratoma, where we observed more COVID-19 cases . Levels of stress and anxiety depending on the number of cases reported in a given area, as that has been reported in China . Gestational age is another key factor that influences the onset of stress and anxiety, and this influence is much greater when gestational age is equal or less than 9 weeks. Women with a gestational age ≤ 34 weeks appeared to be less prone to stress. Childbirth leads to increased hormones, which is likely to induce stress[24, 25]. The onset of pregnancy is featured by physiological and psychological changes that can influence pregnant women. Studies on pregnant women's life quality indicate that the mental quality of life may increase or maintain from the first term of pregnancy , which implies that this period is stressful. Many studies have also shown the essential predictive role of gestational age in prenatal anxiety .
Along with gestational age, the number of pregnancies was associated with stress. This number was high among non-stressed women; in fact, primigravidae may have greater psychological effects compared to multigravidae. The average abortion score was lower among anxious pregnant women. We noticed that multigravidae experienced more abortions (additional file1) in this study, and they probably adapted themselves psychologically over time. The average score of COVID-19 symptoms awareness was lower among women with high levels of anxiety. Knowing the symptoms of COVID-19 may lead to better prevention against the disease and therefore reduce fear and anxiety. This knowledge depends on the level of education; in fact, women with higher education had better knowledge of symptoms of COVID-19 (Additional file1).
Interestingly, our results showed that the number of people in households and monthly incomes were associated with anxiety, and this association was indirectly proportional to these factors. Over 91% of households with five were made up of women in the first trimester of pregnancy (Additional file1). Moreover, even though a pregnant woman lives in an individual comfort with a relatively high income, some factors such as fear of losing her job or getting infected by the virus and concerns about pregnancy outcomes may negatively impact her mental health, . Finally, conditions of monthly incomes data collection might also be subject to social desirability bias.
This study presents some limitations:
1-Psychometric tools for measuring stress and anxiety are not specific to pregnant women, and they have not yet been validated in Guinea. However, these tools show a good internal consistency with respect to Cronbach's α = 0.83 and Cronbach's α = 0.70 for stress and anxiety (Additional file1).
2- Transformation of the variables of interest in binomial variables induces a loss of information, but it still offers the advantage of providing a picture of psychological problems. And we also believe that only a perfect physical examination could distinguish moderate cases of stress and anxiety from severe cases.
3- It is difficult to prove causal associations with the type of study (cross-sectional survey) that we used, for we only interviewed each participant once.
4- Failing to take into account other factors that might lead to psychological problems, such as restrictive measures of COVID-19 and risk of having a long interview, we limited the questionnaire length to a bare minimum.
5- This study is not necessarily representative of all pregnant women in Conakry, for we have selected only a few centres; however, with this sample size, it is not that far from the real situation. For an in-depth exploration of psychology, it would have been interesting to integrate the socio-anthropological dimension.
Despite all its limitations, our study fills up this scarcity of information on COVID-related psychological problems amongst pregnant women in Guinea.