Twice as many pregnant women experienced anxiety and depression during the first COVID-19 lockdown in the Netherlands compared to the number during the 'old normal'. The women experienced many worries about the new and unknown virus, diminished social contacts and loss of work and income. In addition, the supporting role of the partner increased, but social and healthcare support fell short. These are the main conclusions of researchers from the Radboudumc, published in Scientific Reports.
Pregnant women are more susceptible to anxiety and depression, because of the major hormonal and biological changes in their bodies. A new virus with far-reaching consequences for the whole world adds many extra worries. An important protective factor against stress is the support of others: the partner, the social network and especially healthcare. The COVID-19 pandemic and the first lockdown threw a spanner in the works for these last two groups in particular.
The combination of extra worries and reduced support contributed to a doubling of anxiety and depression among pregnant women during the pandemic. The research team based this conclusion on an online survey. They recruited more than 1,400 women before the pandemic in the period 2017-2018, and another more than 1,400 women during the first lockdown in the Netherlands, in April and May of 2020. The numbers: depression increased from 6 to 12%, and anxiety from 24 to 52%. This is in line with the results of similar studies abroad.
Pregnant women faced many worries during the pandemic. Stefania Vacaru, researcher at the Donders Institute for Brain, Cognition and Behavior at Radboudumc, explains: "In the first lockdown, little information existed about the virus and hospitals were overloaded. This created much uncertainty amongst pregnant women. Can the virus get to the baby through the placenta? Does the virus have adverse effects on the development of the unborn child? Will I be able to go to the hospital when I have to give birth?"
In addition to COVID-19 related concerns, stress around work, financial situation and social support were at play. A striking result was that while financial concerns were common, they contributed relatively little to the perception of stress. Possibly because it was not yet clear how long the crisis was going to last. The researchers also indicate that the financial support from the government, which was set up very quickly during the first lockdown, made a positive contribution.
While concerns increased, support for pregnant women actually crumbled. Vacaru: "Because of the lockdown restrictions, women maintained far fewer in-person social contacts. In addition, the healthcare system was under high pressure. Visits to the midwife changed drastically: they were shorter, women were not allowed to bring a companion and sometimes the check-up took place online or by telephone. While in-person social and healthcare support decreased, pregnant women relied much more on support from their partners. But apparently this may not have been enough. We see in our results that healthcare support plays the biggest role in protecting against worries and psychological distress."
The researchers emphasize that even before the COVID-19 pandemic, only one in six pregnant women with anxiety or depression received treatment. They therefore argue for increased care during pregnancy with extra attention to the psychological wellbeing of the woman, not only in corona times. Vacaru: "But in times of crisis the care for pregnant women is even more important. It is particularly the healthcare support that needs to be maintained. What also helps is to quickly provide reliable information about the effects of a new virus on pregnancy."
The project is part of a long-term study (COPE Study) with five rounds of measurements. Tracking women at multiple time points during the pandemic is important to find the most vulnerable women and prevent mental health problems. In follow-up studies, researchers are looking at the effects of prenatal maternal stress during the pandemic on the six-month-old baby. They also examined pregnant women during the second lockdown. These results will follow soon.
About the publication
This research was published in Scientific Reports: The Risk and Protective Factors of Heightened Prenatal Anxiety and Depression during the COVID-19 Lockdown. Stefania Vacaru, Roseriet Beijers, Pamela D. Browne, Mariëlle Cloin, Hedwig van Bakel, Marion I. van den Heuvel, Carolina de Weerth.
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