This study describes how pregnant women managed to cope with the lockdown in Italy. We found a high score for anxiety and depression, despite it cannot be compared to the same score on the same population before the pandemic. Our survey also suggests that the lockdown made it more difficult for pregnant women to exercise for 150 minutes per week in accordance with the ACOG guidelines (15), and we can assume that a reduction in physical exercise will affect the quality of life of pregnant women, as demonstrated in previous studies (16). On the other side it seems that staying at home facilitated the approach to healthy eating, for the group with the partner’s support and a better socio-economic status. This is an interesting data that deserves more investigations and it is a starting point to develop new strategies for public health.
Among women who gave birth during the pandemic, although three-fourths of the respondents declared to be afraid of giving birth during such a complex period, the overall experience was as expected or better than expected for 87% of the population. Despite more than half of the new-mothers reported a negative influence on the baby’s management and more than one-third of them reported a negative influence on their breastfeeding experience, the breastfeeding rate is consistent or even better than the ones before the pandemic (17), suggesting a slight discrepancy between expectations/perceptions and actual facts, probably due to the anxiety and depression characteristics found in our sample. More than half of new-mothers received no support for breastfeeding after hospital discharge; however almost all of the respondents have continued to breastfed their babies when discharged at home. It could be inferred that, in the impossibility to rely on external support, new-mothers have empowered their internal resources with satisfying results.
The high level of anxiety and depression is consistent with other studies (8) (9). The prevalence in the first trimester is confirmed (9) while, differently from another study (8) in our survey this data was not correlated with age, primiparity and area of living. The correlation with economic difficulties and education is consistent with the literature (16), and some studies suggest that COVID 19 pandemic may even worsen the social inequalities (18). Regarding the fact that a reduction of face to face visits could have occurred to women during the restrictions; a recent survey shows that patients are actually open to alternative models of prenatal care, including remote monitoring(19). Future survey could be done in the same population in order to find out if some changes are considered positively. According to a Cochrane review (20) communicating results of medical investigations by mobile phone messaging may make little or no difference to women's anxiety overall or in women with positive test results, but may reduce anxiety in women with negative test results. We cannot exclude that this method will be more largely implemented in future times, after the COVID-19 emergency and the lesson it gave us about face-to-face contact.
A higher prevalence of anxiety and depressive symptoms in pregnant and new-mother populations should be a public health issue, and screening for perinatal depression and anxiety should be considered during a pandemic. Under the circumstances of social distancing and isolation, psychological hotlines and online counseling would be a smart strategy to manage perinatal mental illness. The same strategy would be useful to help new-mothers with the baby management. Healthcare professionals, should also ensure patients feel supported by continuing their routine prenatal care through tele-medicine visits (21). Clinicians might also consider recommending and encouraging “home” physical exercise, especially in women in the first trimester, who might be the most worried about the sudden change of their lives.
Isolation, increased stress, and sedentary lifestyle in pregnancy can also lead to adverse pregnancy outcomes, such as preterm birth, gestational diabetes and low birth weight (22)(23). This survey is also a baseline questionnaire for those women who gave consent to be contacted, and they will be followed up as a cohort in order to identify possible complications. In a further part of our project, we are going to describe in greater detail how the lockdown influenced neonatal outcomes.
The first limitation of the present study is related to the non-random sampling: women are enrolled by newspaper advertisements, social media and the snow-ball method; the completeness checks process was not exhaustive. A second limitation is the lack of validated questionnaire designed to capture such a delicate and unique moment. Third, the assessment of depressive and anxiety symptoms through a short scale which relied on a self-reported measure and does not provide a diagnosis. Although these limits, this is the first study to assess some aspects of the lifestyle of pregnant women and new-mothers during the lockdown in Italy. Besides, the web-based method is a strength because it gave us the opportunity to interview a geographically dislocated population during a short time in the lock-down period.
Given the unicity of this SAR-CoV2 pandemic we tried to give an overview of the experience of Italian pregnant women and new-mothers during the lockdown. Next steps will be to incorporate those findings in political choices. The WHO Executive Board recognizes the need to include women in decision making for outbreak preparedness and response, however there is still inadequate women's representation in national and global COVID-19 policy spaces (24). It is also important that health professionals commit themselves to help pregnant women and new-mothers to overcome these difficult times.