Background Anxiety and depression symptoms in pregnancy typically affect between 10 and 25% of pregnant individuals. Elevated symptoms of depression and anxiety are associated with increased risk of preterm birth, postpartum depression, and behavioural difficulties in children. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond. Methods We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants in Canada were surveyed in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, and social support. Results We found substantially elevated anxiety and depression symptoms compared to similar pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression and 57% reporting clinically relevant symptoms of anxiety. Higher symptoms of depression and anxiety were associated with more concern about threats of COVID-19 to the life of the mother and baby, as well as concerns about not getting the necessary prenatal care, relationship strain, and social isolation due to the COVID-19 pandemic. Higher levels of perceived social support and support effectiveness, as well as more physical activity, were associated with lower psychological symptoms. Conclusion This study shows concerningly elevated symptoms of anxiety and depression among pregnant individuals during the COVID-19 pandemic, that may have long-term impacts on their children. Potential protective factors include increased social support and exercise, as these were associated with lower symptoms and thus may help mitigate long-term negative outcomes.

Mental health problems are common in pregnancy, typically affecting between 10-25% of pregnant individuals. Elevated symptoms of depression and anxiety can negatively impact both the pregnant individual and developing fetus. The current COVID-19 pandemic is a unique stressor with potentially wide-ranging consequences for pregnancy and beyond. We assessed symptoms of anxiety and depression among pregnant individuals during the current COVID-19 pandemic and determined factors that were associated with psychological distress. 1987 pregnant participants were surveyed across Canada in April 2020. The assessment included questions about COVID-19-related stress and standardized measures of depression, anxiety, pregnancy-related anxiety, sleep and social support. We found substantially elevated psychological distress compared to similar pre-pandemic pregnancy cohorts, with 37% reporting clinically relevant symptoms of depression, 57% reporting clinically relevant symptoms of anxiety, and 68% reporting elevated pregnancy-related anxiety. Higher levels of social support and longer sleep duration were associated with lower psychological symptoms across domains. This study shows concerningly elevated levels of psychological distress among pregnant individuals during the COVID-19 pandemic, that may have long-term impacts on their children. Potential intervention targets are needed in addition to improving protective factors related to increased social support and sleep -- these should be urgently considered to mitigate long-term negative outcomes.

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As the novel coronavirus (COVID-19) spread across Canada in March 2020, provinces imposed restrictions. These changes impacted how pregnant individuals received prenatal care and experienced childbirth. The stress caused by these changes may negatively affect the well-being of pregnant individuals with impacts on the developing child. This study investigated the impact of the pandemic on prenatal care and birth plans of pregnant individuals in Canada and potential associations with maternal mental health. Data from 4,604 participants was collected from English- and French-speaking Canadians between April 5 and June 1, 2020 as part of the Canada-wide Pregnancy During the COVID-19 Pandemic study. Symptoms of maternal depression, general anxiety, and pregnancy-related anxiety were assessed. Participants also answered questions about disruptions and changes to prenatal care and their birth plans due to the COVID-19 pandemic. Logistic regression was used to estimate associations between prenatal care disruptions and maternal mental health. Cancellation of prenatal appointments and birth plan changes (specifically changes to childcare during birth and change of support person attending the birth) were significantly associated with greater odds of experiencing clinically elevated depression, anxiety, and/or pregnancy-related anxiety symptoms. These results highlight the need for reliable and accessible prenatal care during the pandemic, such as the integration of mental health screenings and co-ordination of prenatal care providers.

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Background The COVID-19 pandemic and countermeasures implemented by governments around the world have led to dramatically increased symptoms of depression and anxiety. Pregnant individuals may be particularly vulnerable to the negative psychological effects of COVID-19 public health measures because they represent a demographic that is most affected by disasters and because pregnancy itself entails significant life changes that require major psychosocial and emotional adjustments. Objective The PdP study was designed to investigate the associations among exposure to objective hardship caused by the pandemic, perceived stress and psychological distress in pregnant individuals, and developmental outcomes in their offspring. Methods The PdP study comprises a prospective longitudinal cohort of individuals who were pregnant at enrollment, with repeated follow-ups during pregnancy and the postpartum period. Participants were eligible if they were pregnant, ≥17 years old, at ≤35 weeks of gestation at study enrollment, living in Canada, and able to read and write in English or French. At enrollment, participants completed an initial survey that assessed demographic and socioeconomic characteristics, previous pregnancies and births, prepregnancy health, health conditions during pregnancy, medications, psychological distress, social support, and hardships experienced because of the COVID-19 pandemic (eg, lost employment or a loved one dying). For the first three months following the initial survey, participants received a monthly email link to complete a follow-up survey that asked about their experiences since the previous survey. After three months, follow-up surveys were sent every other month to reduce participant burden. For each of these surveys, participants were first asked if they were still pregnant and then routed either to the next prenatal survey or to the delivery survey. In the postpartum period, surveys were sent at 3, 6, and 12 months of infant age to assess maternal stress, psychological distress, and infant development. Results Participant recruitment via social media (Facebook and Instagram) began on April 5, 2020, and is ongoing. As of April 2021, more than 11,000 individuals have started the initial survey. Follow-up data collection is ongoing. Conclusions This longitudinal investigation seeks to elucidate the associations among hardships, maternal psychological distress, child development during the COVID-19 pandemic, and risk and resilience factors that amplify or ameliorate these associations. The findings of this study are intended to generate knowledge about the psychological consequences of pandemics on pregnant individuals and point toward prevention and intervention targets. International Registered Report Identifier (IRRID) DERR1-10.2196/25407

The impact of the COVID-19 pandemic on rates of alcohol and substance use raises significant concerns, as substances may be coping mechanisms for social isolation and/or disruptions to employment and the economy. Pregnant women are currently experiencing unusually high rates of anxiety and depression symptoms and may be especially affected. We analysed results from an ongoing study of pregnant individuals in Canada: Pregnancy during the COVID-19 Pandemic. Participants were asked about current substance during pregnancy, and concerns about the threat of COVID-19 to their baby’s life, decreased quality of prenatal care, and whether they felt more socially isolated, experienced financial difficulties, or lost their job. The percentage of participants reporting use during pregnancy was 6.9% for alcohol, 3.7% for cannabis, 3.5% for tobacco, and 0.2% for illicit drugs. Odds for cannabis use increased by 0.9% for each unit increase in concern about lower quality prenatal care and by 2.1% for each unit increase in financial difficulties. Odds for tobacco use increased by 220.0% for loss of employment. COVID-19 concerns did not significantly predict alcohol use. Comprehensive public health strategies, including access to perinatal, mental health, and financial supports, as well as education around the effects of prenatal exposures and the possible effects of COVID-19 on the mother and baby, are important to facilitate healthy coping mechanisms for mothers, reduce substance use in pregnancy, and mitigate poor perinatal and long-term neurodevelopmental outcomes for babies.