After the outbreak of COVID-19, people showed more negative emotions and less positive emotions, which was supported by the broaden-and-build theory(i.e., people exhibited more negative emotions for self-protection).8 The SARS outbreak in 2003 was not only deemed as a medical incident but as a mental health catastrophe with a response compatible to that of other main disasters.9 In the same way, the mental impact of COVID-19 pandemic deserves equal attention. Our results revealed that the SAS and SDS standard scores of pregnant women during the COVID-19 outbreak were markedly higher than those of general adults in some regions of China (P<0.05). It uncovered that pregnant women were more likely to develop anxiety and depression during the outbreak. Thus, it is of great practical significance to analyze the affecting factors, their cognition, behavioral responses and to provide specific guidance that meet their psychological needs during the COVID-19 pandemic.
3.1 Factors influencing pregnant women’s psychological status
In our research, we found that age, levels of education, and trimester of pregnancy were all factors relevant to pregnant women’s psychological status during the COVID-19 pandemic. We also found that the rate of poor mental health was higher in the 18-30 age group than above the 30 age group. In addition, a study showed that a lower level of education was associated with a higher prevalence of anxiety and depression status,10 which was consistent with the results of our study. It is likely because people with a higher degree of education and age have keen self-protection awareness, and they may collect relevant information and knowledge of the epidemic on their own initiative in various ways. Therefore, they have a less cognitive bias towards the epidemic diseases and make corresponding psychological preparations in advance. The results also disclosed that pregnant women in early pregnancy were more likely to develop mental health problems, which might be due to morning sickness and their lack of pregnancy experience in early pregnancy. Additionally, the maternal immune system in early pregnancy is very sensitive,11 which also makes them more likely to develop anxious and depressive symptoms.
3.2.Cognitive and behavioral responses of pregnant women during the COVID-19 outbreak
A number of scholars demonstrated that childbirth was a stressor, and all the pregnant women would show diverse degrees of anxiety or depression symptoms before delivery. Besides, the quality of life model of depression and related disorders indicated a direct inverse relationship between life satisfaction and anxiety.12 Thus, if a person has always been in a low emotional state, he/she may gradually feel less hopefulness and happiness in life. The findings of the present study showed that pregnant women with anxiety or depression tended to more worry about the domestic epidemic during the COVID-19 outbreak. Most of them considered that the epidemic had a great impact on their lives, and they worried that they had not prepared adequate protective supplies. Additionally, compared with pregnant women with good mental health, a higher proportion of those who with negative emotions thought that their family members cared a little about them, and they were not ready to be a mother as well. Gan, Liu, and Zhang compared how Beijing university students coped with the SARS epidemic with how they disposed daily stressful events, indicating that individual had a propensity to be less flexible to handle the SARS epidemic than in their usual practice of handling stress. And they tended to use more emotion-focused coping to handle such events.13 Therefore, It is very necessary to have proper guidance in this case. For pregnant women with symptoms of anxiety or depression, they really needed psychological counseling and proper intervention. High levels of pregnancy-related anxiety have been found to be associated with preterm birth and low birth weight.14 Futhermore, prolonged depression during pregnancy may elevate the risks of adverse birth outcomes, including premature birth, low birth weight, and delayed development.3 These adverse outcomes indicated that a comprehensive assessment of mental health was of great importance to identify pregnant women who had anxiety or depression early during the epidemic.
3.3 Measures to improve pregnant women’s psychological health
3.3.1 Popularized knowledge about COVID-19
Lessons learned from the SARS outbreak in 2003 suggested that knowledge and attitudes towards infectious diseases were associated with a level of anxiety among the population.15 Anxiety and depression, exacerbated by uncertainties and intensification of the information flow, will increase vastly. Negative physiological impact of stress will come out.16 Therefore, improving cognition and knowledge is conductive to enhance the ability of stress responses. We found that the majority of pregnant women worried to know whether their children could be born healthily and smoothly. Thus, most of pregnant women would like to acquire relevant knowledge: personal protection during pregnancy, the pregnant women’s susceptibility to COVID-19, and intrauterine transmission. Fortunately, there is no evidence of Sars-Cov-2 transmission in utero or placenta from infected pregnant women to fetuses in the global pandemic of COVID 19 at present.17 Besides, Chen et al. found no evidence of Sars-Cov-2 virus particles in pregnant products or newborns. Moreover, clinical symptoms of pregnant women with confirmed COVID-19 infection are similar to those non-pregnant women with confirmed COVID-19 infection, demonstrating that the clinical process and results are more optimistic than Sars-Cov-1 infection.5
3.3.2 Provision of health care services
To avoid further spread of the epidemic, people are advised to stay at home, causing difficulty for numerous pregnant women to go to the hospitals. Although hospital visits may increase the risk of infection, the lack of medical care during pregnancy may be further detrimental. Importantly, intrauterine pregnancy and prenatal testing are significant. Statistics showed that more than 2% of pregnancies are ectopic, and congenital disabilities or genetic disorders occurred in approximately 3-5% of pregnancies. Cancellation of a visit may reduce the possibility of viral infection, while sequelae may leave a greater impact.18 To solve this problem, from the results, we recommend hospitals to take the following measures: (1) make appointments by schedule for production inspections, (2) provide online consultation by public account or App, (3) popularize the protection knowledge related to COVID-19 during pregnancy.
3.3.3 Relieving negative emotions
The results showed that 80.17% of pregnant women would relax themselves (i.e., listening to music, watching movies, etc.) to relieve their negative emotions, and 71.38% of pregnant women would choose to chat with their family members or friends. During the outbreak of COVID-19, residents are advised to stay at home. Hence, it is necessary to create a better family atmosphere and care more about pregnant women, which can reduce the incidence of depression and anxiety.
3.4 Limitations of the survey
We conducted a timely investigation among pregnant women during the outbreak of COVID-19. This cross-sectional study aims to reflect the psychological condition of pregnant women during the outbreak and to analyze the relevant factors. There are some shortcomings in the current research. First, we conducted the survey by means of online questionnaires, which might ignore those pregnant women who did not have access to the Internet. Secondly, the limitation of the regions involved may cause information bias.