The study was conducted between March 30 and May 30, 2020, with a total of 526 participants aged 18–43 years with a mean age of 28.35 (SD: 5.43) years.
Of the pregnant women, 7% were healthcare workers. In terms of the number of children that they had, 45.8% were pregnant for the first time; 32.7% had one child, 12.7% two children, and 87% had ≥ 3 children.
A total of 97.5% of the respondents were married. In terms of educational background, 14.1% were primary school graduates, 17.9% were secondary school graduates, 24.7% were high school graduates, 12.7% had associate degrees, and 30.6% had undergraduate and graduate degrees.
Of the respondents, 87.3% were non-smokers. In terms of pregnancy week, 23.8% were in gestation week 14, 29.5% were in gestation week 14–28, and 46.7% were in gestation week > 28.
In terms of the number of people living in the household, 43% responded 1–2 people, 49.1% responded 3–5 people, and 14.6% responded 5–10 people. Those who had been admitted at the emergency service 1–5 times over the past year accounted for 49.1% of all included cases, and those admitted 5–10 times accounted for 14.6%. Those with a history of contact with an individual suspected of COVID-19 in the previous 14 days accounted for 1.5% of the cases, while those who were not sure of contact accounted for 3.4%. Public transport use rate over the past month was 23%. In addition, 49% of participants touched their faces less than 10 times a day, while 40.5% touched their faces more than 10 times a day. Moreover, 20.2% of the participants did not undergo routine pregnancy checks, 18.8% did so occasionally, and 61% did so regularly.
In terms of risk factors, 3% of the participants had diabetes mellitus (DM), 2.3% hypertension, 5.3% lung disease, 1.3% cancer, 4% heart disease, 1.5% liver disease, 1.1% renal disease, 3.8% thyroid disease, and 2.9% other risk factors, whereas 79.8% of the participants had no risk factor.
A total of 8.7% of the participants believed that the use of antibiotics is effective against COVID-19. Additionally, 53% thought that social media was being efficiently used to inform the society about COVID-19, and 4.9% of the cases had been previously vaccinated against influenza.
Those who thought that they were well informed about how COVID-19 is transmitted accounted for 77.4% of the participants; those who thought that they were well informed about its symptoms also accounted for 77.4%. Further, 86.1% of the participants thought that the most important symptom of COVID-19 is fever, while 62.5% thought it is cough, 70.7% shortness of breath, and 6.1% other symptoms. In addition, 56.3% of the participants stated that they would be interested in getting vaccinated if there was a vaccine against COVID-19, 18.1% thought that their families and friends were well informed about COVID-19, 67.7% thought that the pandemic was preventable, 80.4% thought the pandemic was deadly, 58.4% found the measures taken by the Ministry of Health against the pandemic to be satisfactory, and 33.1% were informed by healthcare workers.
Among the measures taken by the participants against the COVID-19 pandemic, frequent hand washing was 88.6%, use of hand sanitizer/cologne was 59.9%, avoiding crowds was 83.3%, wearing a mask was 61.6%, wearing gloves was 26.4%, and staying home for protection was 3.2%.
Among the measures taken to reduce the number of cases and deaths related to COVID-19 in Turkey, most were those taken by the Ministry of Health, which accounted for 23%. This was followed by staying home unless necessary (19.2%) and cleaning habits (16.2%). Furthermore, 93.5% of the participants expressed that they would perform self-protection by quarantining themselves at home for 14 days if they came in contact with individuals with suspected COVID-19, 96.4% expressed that they would not visit any relative or friend within the first 14 days following their arrival from other countries. 86.9% stated that they were following up-to-date information about COVID-19 in Turkey and around the world, and 24.7% thought the COVID-19 pandemic was overrated. Additionally, 51.1% of the participants thought that they needed to be informed about COVID-19, 42.4% stated they would accept inpatient treatment if recommended by their doctor because of COVID-19, 51% stated they would provide swab samples if requested by their doctor after they had contacted an individual diagnosed with COVID-19, and 42.7% stated that they would share their diagnosis of COVID-19 with everyone if diagnosed with COVID-19.
The results outlined above include the distribution of the responses given by the pregnant women to the 19 questions asked to assess their awareness of COVID-19. A scoring system of 19 questions to determine the level of awareness in pregnant women was created. Every correct answer indicating awareness was converted into a hundred-point scale for standardization. Percentile values ranked at the 33.3 and is categorized as average, and awareness was classified. The scores of awareness of COVID-19 were 5.26–100, with a mean score of 60.13 ± 14.81. Of the participants, 3.6% who scored 33.3 and below had low awareness, 58.7% who scored 33.3–66.6 had moderate awareness, and 37.6% who scored ≥ 67 had high awareness. (Table 1)
Table 1
Distribution of COVID-19 Awareness Scores
| COVID-19 Awareness Scores |
Min-Max | 5,26–100 |
Avr ± SD | 60,13 ± 14,81 |
Low Awareness Levels | 19 (3,6) |
Moderate Awareness Levels | 309 (58,7) |
High Awareness Levels | 198 (37,6) |
There was no statistically significant relationship between age and scores of COVID-19 awareness. (r=-0,016; p = 0,712; p > 0,05). There was also no statistically significant difference between the scores of COVID-19 awareness in terms of educational background (p > 0,05). There was no significant difference among the scores of COVID-19 awareness in terms of being a healthcare worker or not (p > 0,05). In terms of number of children, however, there was a significant difference among the scores of COVID-19 awareness (p < 0.05): the awareness increased as the number of children increased. The awareness score of women who had no children was significantly lower than that of those who had three children (p = 0,016; p < 0,05).
In terms of use of public transport in the previous 1 month, there was no significant difference among the scores of COVID-19 awareness (p > 0,05).
There was no significant difference among the scores of COVID-19 awareness in terms of having contacted anyone with suspected COVID-19 in the previous 14 days (p > 0,05). There was also no significant difference among the scores of COVID-19 awareness in terms of pregnancy week (p > 0,05). There was a significant difference among the scores of COVID-19 awareness in terms of the number of people living in the household (p < 0.05); the awareness score of those with a household of 1–2 people was significantly lower than that of those with a household of 3–5 people (p:0,012; p < 0,05). There was a significant difference among the scores of COVID-19 awareness in terms of visiting the healthcare facility for routine pregnancy check-ups (p < 0.05); the awareness score of those continuing routine pregnancy check-ups was significantly higher than that of those not undergoing or occasionally undergoing routine pregnancy check-ups (p:0,001; p < 0,01). (Table 2)
Table 2
Evaluations based on COVID-19 Awareness Scores
| COVID-19 Awareness Scores | |
Average | SD | Median | p |
Educational Status | Primary School | 60,88 | 17,73 | 63,16 | a0,152 |
Middle School | 63,38 | 14,76 | 63,16 | |
High School | 59,72 | 16,64 | 57,89 | |
Associate’s degree | 58,52 | 14,24 | 57,89 | |
From Bachelor’s degree to Doctorate | 58,91 | 11,58 | 57,89 | |
Health-care worker | Yes | 58,80 | 13,72 | 57,89 | b0,280 |
No | 62,00 | 15,49 | 63,16 | |
Number of children | Zero | 58,62 | 13,95 | 57,89 | a0,025* |
1 child | 60,86 | 14,59 | 63,16 | |
2 children | 60,57 | 17,08 | 63,16 | |
3 and more | 64,76 | 15,80 | 63,16 | |
Use of public transportation | Yes | 60,77 | 13,78 | 63,16 | b0,595 |
No | 59,95 | 15,12 | 57,89 | |
Suspected COVID-19 exposure | No | 60,24 | 14,77 | 57,89 | c0,531 |
Yes | 63,16 | 12,89 | 63,16 | |
Not sure | 55,85 | 16,95 | 60,53 | |
Gestational age | < 14 gw | 60,76 | 13,93 | 63,16 | a0,380 |
14–28 gw | 59,14 | 14,23 | 57,89 |
> 28 gw | 60,36 | 15,16 | 57,89 | |
How many people do live in your house? | 1–2 people | 58,59 | 13,63 | 57,89 | 0,011* |
3–5 people | 61,91 | 15,06 | 63,16 | |
> 6 people | 57,06 | 18,38 | 57,89 | |
Routine prenatal visits | Never | 57,69 | 15,87 | 57,89 | 0,001** |
Irregular | 59,62 | 14,18 | 57,89 | |
Regular | 64,43 | 14,94 | 68,42 | |
aOneway Anova test bStudent t test cKruskal Wallis test *p < 0,05 |
In terms of the risk factors of pregnant women, the scores of COVID-19 awareness did not significantly differ in other groups of risk factors, except for those with heart disease (p > 0.05). The awareness score of patients with heart disease was significantly higher than that in those without heart disease (p < 0.05) (Table 3).
Table 3
Evaluation of COVID-19 Awareness Scores according to the risk factors of pregnant women
| COVID-19 Awareness Scores | p |
Average | SD | Median |
Diabetes Mellitus | No | 60,20 | 14,76 | 57,89 | 0,571 |
Yes | 58,22 | 16,81 | 60,53 | |
Hypertension | No | 60,30 | 14,65 | 57,89 | 0,312 |
Yes | 53,07 | 20,38 | 57,89 | |
Lung Diseases | No | 60,24 | 15,01 | 57,89 | 0,364 |
Yes | 58,27 | 10,90 | 57,89 | |
Cancer Diseases | No | 60,14 | 14,77 | 57,89 | 0,699 |
Yes | 60,15 | 19,66 | 63,16 | |
Heart Diseases | No | 53,13 | 12,88 | 52,63 | 0,016* |
Yes | 60,43 | 14,83 | 63,16 | |
Liver Diseases | No | 60,08 | 14,86 | 57,89 | 0,475 |
Yes | 63,82 | 12,08 | 65,79 | |
Renal Diseases | No | 60,12 | 14,79 | 57,89 | 0,830 |
Yes | 61,40 | 18,13 | 63,16 | |
Thyroid Diseases | No | 59,95 | 14,77 | 57,89 | 0,094 |
Yes | 64,74 | 15,75 | 68,42 | |
Other Diseases | No | 60,05 | 14,78 | 57,89 | 0,399 |
Yes | 63,16 | 16,40 | 68,42 | |
None | No | 59,93 | 15,23 | 63,16 | 0,988 |
Yes | 60,19 | 14,73 | 57,89 | |
Mann Whitney U test *p < 0,05 |
Moreover, 62.9% of the participants thought they were more prone to COVID-19 because they were pregnant, 69% thought their unborn infant could get infected by COVID-19, and 75.1% thought their infant could get infected by COVID-19 through breastfeeding. Because of the concern of getting infected by COVID-19, 14.6% of the participants thought that they would have pain, 7.2% bleeding, 4.2% water-breaking, 14.8% premature birth, and 13.1% miscarriage or stillbirth. In addition, 29.3% used vitamins to boost their immunity against COVID-19 and 68.2% were concerned about family members getting infected by COVID-19. Because of the thought of getting infected by COVID-19, 3.6% of the participants expressed that they experienced numbness or tingling, 14.1% experienced increased body heat, 8.2% experienced weakness or chills, 30.6% had feelings of foreboding, 10.6% had heart palpitations, 3.4% dizziness or drowsiness, 10.5% feelings of drowning, 13.9% difficulty in breathing, 16.5% fear of death, and 12.0% discomfort in the stomach. Additionally, 45.6% thought they would never recover if infected by COVID-19, 44.7% thought that physicians could not diagnose COVID-19 in a timely manner and treat COVID-19 properly, 11.2% considered terminating their pregnancy because of the risk of COVID-19 infection in the womb, 78.3% believed that they now wash their hands more often after coughing, sneezing, and touching the nose than in the pre-pandemic period, and 93.9% avoided leaving home and going outside owing to their concerns regarding COVID-19. If an individual living in the same household is recommended treatment for suspected COVID-19, 57.2% expressed that they would live in separate rooms, 21.2% said they would live in separate houses, and 47.3% expressed that they would be willing to provide a swab sample if requested by their physician upon contacting someone suspected of COVID-19.
These results show the distribution of the participants’ responses to the 15 questions asked to measure anxiety regarding COVID-19 in pregnant women. Based on the responses, we created a scoring system to determine the level of anxiety in pregnant women. Every correct response measuring anxiety was converted into a hundred-point scale for standardization and then assessed. Percentile values ranked at the 33.3 and is categorized as average, and anxiety was classified.
The scores of COVID-19 anxiety ranged from 13.33 to 86.67, with a mean score of 53.49 ± 13.63. Those with a score of ≤ 33.3 were classified as having low anxiety and accounted for 11.4% of the respondents; those with scores of 33.3–66.6 had a moderate level of anxiety and accounted for 66.2% of the respondents, and those with a score of ≥ 67 had a high level of anxiety and accounted for 22.4% of the respondents. (Table 4)
Table 4
Distribution of COVID-19 Anxiety Scores
| COVID-19 Anxiety Scores |
Min-Max | 13,33–86,67 |
Avr ± SD | 53,49 ± 13,63 |
Low Anxiety Levels | 60 (11,4) |
Moderate Anxiety Levels | 348 (66,2) |
High Anxiety Levels | 118 (22,4) |
There was no statistically significant relation between age and score of COVID-19 anxiety (r=-0,043; p = 0,322; p > 0,05). There was also no significant difference among the scores of COVID-19 anxiety in terms of number of children and whether the participants were health workers or not (p > 0,05).
There was no statistically significant difference among the scores of COVID-19 anxiety in terms of public transport use over the past 1 month and educational background (p > 0,05). In terms of contact with an individual with suspected COVID-19 in the past 14 days, there was a significant difference among the scores of COVID-19 anxiety (p < 0.05). It was found that those with a history of contact had significantly higher anxiety scores than those without a history of contact (p = 0,014; p < 0,05).
There was a significant difference among the scores of COVID-19 anxiety in terms of gestation week (p < 0.05), with the highest level of anxiety in the 2nd trimester and lowest level of anxiety in the 1st trimester (p = 0,014; p < 0,05). In terms of household size, there was no significance among the scores of COVID-19 anxiety (p > 0,05). There was a significant difference among the scores of COVID-19 anxiety in terms of visiting the healthcare institution for routine pregnancy check-ups (p < 0.05). Those visiting regularly had significantly higher anxiety scores than those not visiting at all or visiting occasionally for routine pregnancy check-ups (p:0,008; p < 0,01). (Table 5)
Table 5
Evaluations based on COVID-19 Anxiety Scores
| COVID-19 Anxiety Scores | |
Average | SD | Median | p |
Educational Status | Primary School | 53,15 | 16,22 | 53,33 | a0,992 |
Middle School | 54,11 | 12,36 | 53,33 | |
High School | 54,26 | 12,75 | 53,33 | |
Associate’s degree | 53,63 | 15,11 | 53,33 | |
From Bachelor’s degree to Doctorate | 52,63 | 13,20 | 53,33 | |
Health-care worker | Yes | 54,94 | 13,88 | 53,33 | b0,284 |
No | 54,38 | 13,95 | 53,33 | |
Number of children | Zero | 53,44 | 12,85 | 53,33 | a0,611 |
1 child | 53,06 | 13,69 | 53,33 | |
2 children | 53,43 | 16,84 | 53,33 | |
3 and more | 55,51 | 12,42 | 60,00 | |
Use of public transportation | Yes | 52,78 | 13,92 | 53,33 | b0,511 |
No | 53,71 | 13,55 | 53,33 | |
Suspected COVID-19 exposure | No | 53,25 | 13,67 | 53,33 | c0,044* |
Yes | 62,17 | 13,06 | 59,67 | |
Not sure | 57,78 | 12,10 | 56,67 | |
Gestational age | < 14 gw | 51,60 | 13,14 | 53,33 | a0,047* |
14–28 gw | 55,13 | 12,61 | 53,33 |
> 28 gw | 53,31 | 14,19 | 53,33 | |
How many people do live in your house? | 1–2 people | 53,22 | 12,60 | 53,33 | 0,830 |
3–5 people | 53,82 | 14,22 | 53,33 | |
> 6 people | 52,98 | 15,57 | 53,33 | |
Routine prenatal visits | Never | 51,13 | 15,27 | 53,33 | 0,010* |
Irregular | 53,25 | 12,90 | 53,33 | |
Regular | 56,83 | 13,54 | 60,00 | |
aOneway Anova test bStudent t test cKruskal Wallis test *p < 0,05 |
In terms of risk factors, the scores of COVID-19 anxiety did not differ significantly among the participants, except for those with DM (p > 0.05). Those with DM had significantly higher anxiety scores than those without DM (p < 0,05). (Table 6)
Table 6
Evaluation of COVID-19 Anxiety Scores according to the risk factors of pregnant women
| COVID-19 Anxiety Scores | p |
Average | SD | Median |
Diabetes Mellitus | No | 52,31 | 13,68 | 2 | 0,046* |
Yes | 59,58 | 10,74 | 60,00 | |
Hypertension | No | 53,46 | 13,51 | 53,33 | 0,757 |
Yes | 55,00 | 18,88 | 53,33 | |
Lung Diseases | No | 53,71 | 13,74 | 53,33 | 0,107 |
Yes | 49,76 | 11,11 | 46,67 | |
Cancer | No | 53,47 | 13,63 | 53,33 | 0,484 |
Yes | 55,24 | 14,25 | 60,00 | |
Heart Diseases | No | 53,48 | 13,71 | 53,33 | 0,640 |
Yes | 53,97 | 11,72 | 60,00 | |
Liver Diseases | No | 53,55 | 13,63 | 53,33 | 0,456 |
Yes | 50,00 | 14,25 | 53,33 | |
Renal Diseases | No | 53,46 | 13,66 | 53,33 | 0,607 |
Yes | 56,66 | 11,74 | 53,33 | |
Thyroid Diseases | No | 53,32 | 13,54 | 53,33 | 0,101 |
Yes | 58,00 | 15,46 | 60,00 | |
Other Diseases | No | 53,50 | 13,73 | 53,33 | 0,972 |
Yes | 53,33 | 9,76 | 53,33 | |
None | No | 53,96 | 13,48 | 53,33 | 0,591 |
Yes | 53,38 | 13,68 | 53,33 | |
Mann Whitney U test *p < 0,05 |
There was a statistically significant positive correlation between the scores of COVID-19 anxiety and the scores of COVID-19 awareness (r = 0,252; p = 0,001; p < 0,01). As the awareness level of pregnant women increased, the anxiety level increased as well. (Fig. 1)