In March 2020, the first cases of COVID-19 was emerged in Qom city in Iran (1). The World Health Organization, announced the COVID-19 disease as a pandemic on 11 March 2020 (2). At the present time (8 October 2020) the number of affected people in Iran reached around 448,236 and 27,888 cases died from this disease (3). Four weeks passed from the epidemic of COVID-19 in Iran, in 20th March 2020, the government announced lockdown in most provinces and all obstetrics and midwifery private offices were officially closed and only a few clinics were open in the cities for pregnant women to visit. Anxiety and fear of COVID-19 disease were spread among people as well as pregnant women. Although before the pandemic of COVID-19, pregnant women may were excited about their pregnancy, it replaced by fear after the pandemic of COVID-19 (4).
Health anxiety define as the extensive worry that people experience about their health situation (4). Health anxiety may manifest in two types: illness anxiety disorder and somatic symptom disorder and the symptoms of anxiety may vary from mild to severe that show clinical signs. The pregnancy-specific anxiety is an autonomous anxiety disorder, that when a woman conceives, may has this type of anxiety because of immediate somatic changes, or either illness anxiety disorder (5).
Stress and anxiety during pregnancy are associated with disorders such as preeclampsia, low birth weight, depression and more nausea and vomiting (6). Women with anxiety during pregnancy may experience symptoms such as worry, stress, having difficulty to stay calm, sleep disturbances, having negative thoughts that may prevent good sleep (7). Anxiety during pregnancy mostly is accompanied with depression (8). In the other hand, disorders such as depression may deteriorate the outcomes of pregnancy (9). Worry during the pandemic of COVID-19 among pregnant women may cause them to avoid attending the clinics for regular prenatal care or undergo unnecessary cesarean section because of fear of mother to neonate disease transmission (10).
Although pregnant women are susceptible to respiratory infection during pregnancy, a recent WHO report suggested that the risk of transmission of Covid-19 in pregnancy is similar to the risk in a non-pregnant population (11). However, other studies have suggested that viral respiratory diseases may cause pneumonia in pregnant women, which may lead to premature rupture of membranes, preterm labor, intrauterine fetal demise, intrauterine growth retardation and even neonatal death (12). Also, SARS-CoV-2 may cause decrease in angiotensin and worsen vasoconstriction, inflammation and coagulopathy that are similar to signs of preeclampsia patients (13). Limited evidence from pregnant women affected with COVID-19 in China and the USA reveal that more than 95% of these women delivered by cesarean section, as the general idea is the maternal respiratory disease will be worsen with normal vaginal delivery (the rate of cesarean section in the USA and China is 32% and 54.5% respectively) (14-16).
The Corona virus is a novel disease and its dimensions are unknown. Therefore, this study designed to investigate the health anxiety among pregnant women in different trimesters in Iran.