COVID-19 Pandemic and Maternal Psychological Wellbeing During the Malaysian Movement Control Order: A Cross-Sectional Study

Abstract

Background: COVID-19 pandemic had resulted in nationwide lockdown as a disease control measure. Potential harm to self and baby due to COVID-19 infection as well as uncertainties about delivery are among contributors to maternal anxiety. We aimed to assess the prevalence of psychological distress among pregnant women during the Malaysian Movement Control Order (MCO).Methods: A cross-sectional study was conducted between May and June 2020 in a teaching hospital in Kuala Lumpur, Malaysia. A self-administered electronic questionnaire was distributed which included the following; (1) Depression, Anxiety and Stress Scale-21 (DASS 21), (2) Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), (3) MCO effect questionnaire, and (4) newly designed COVID-19 pregnancy-related anxiety. Chi-square test and logistic regression were performed to determine significant associations whilst mean scores comparison were conducted through Mann-Whitney-U-test.Results: Four hundred and fifteen women were included in the final analysis. The prevalence of psychological distress among our cohort was 14.7%; with a two-fold increase of risk among the non-Malays (AOR 1.98, 95% CI 1.00–3.89) whilst a greater number of social support showed a protective effect (AOR 0.51, 95%CI 0.28–0.92). Malay ethnicity (p < 0.001) alongside greater household income (p = 0.014) were positive predictors of a higher sense of maternal wellbeing. Multiparous women and those of higher economic status experienced the more negative effect of the MCO. Around 88% of our women reported a higher level of COVID-19 pregnancy-related anxiety. Younger (p = 0.017) and first-time mothers (p = 0.039) were more likely to be anxious. Although adequate maternal knowledge on COVID-19 was associated with a greater sense of maternal wellbeing (p = 0.028), it was also linked to a higher level of COVID-19 related anxiety (AOR 3.54, 95% 1.29–9.70).Conclusion: There was a relatively low prevalence of psychological distress among expectant mothers in Malaysia during the first wave of the COVID-19 pandemic. Expectant mothers should receive accurate and reliable information on the effect of COVID-19 on pregnancy to relieve some maternal anxiety. Maternal health screening is important to identify individuals who would benefit from extra support and mental health intervention, especially in prolonged lockdown.

Prevalence of Perinatal Anxiety and Related Disorders in Low- and Middle-Income Countries

“…Generalized anxiety disorder (including anxiety not specified) was the most commonly reported anxiety disorder, examined by 184 of 203 studies (90.6%) . The pooled point prevalence for generalized anxiety disorder was 22.2% (95% CI, 19.4%-25.0%; n = 173 553).…”

“…Our search identified 10 617 studies; 1231 full texts were reviewed, and of these, 203 studies were included (Figure 1; eTable 2 in Supplement 1). Cumulatively, outcomes were reported for 212 318 perinatal women (from conception to 12 months post birth) from 33 LMICs. The prevalence estimates of 6 anxiety and related disorders were reported: generalized anxiety disorder, social anxiety disorder, posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, and adjustment disorder.…”

Maternal COVID-19 vaccine acceptance among Malaysian pregnant women: A multicenter cross-sectional study

“…Our recently published data indicate that over four-fifths of our obstetric patients expressed worry about the risk of COVID-19 infection to themselves and their babies (21). A study among pregnant individuals in Singapore during the early wave of the pandemic demonstrated that women who associated COVID-19 infection with fetal anomalies and intrauterine fetal death had significantly higher anxiety scores (41).…”

“…This questionnaire consists of five items that evaluate maternal anxiety concerning COVID-19 infection to self and baby as well as pregnancy complications such as miscarriage, fetal anomaly, and preterm birth. This questionnaire demonstrated good internal consistency with Cronbach's alpha of 0.928 (21). The total score ranged between 5 to 25, and a 50% cut-off level (score ≥13) indicates greater maternal anxiety.…”

“…It consists of 7 items, each scored from 0 to 3, with total scores ranging from 0 to 21. The GAD-7 anxiety score is categorized into minimal (0-4), mild (5-9), moderate (10-14), and severe (15)(16)(17)(18)(19)(20)(21). The Bahasa Malaysia version of GAD-7 was validated in the primary care setting by Sidik et al (22) and demonstrated good sensitivity, specificity, and concurrent and convergent validity (22).…”