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Pregnancy During Pandemic May Take a Toll on Your Mental Health: Harvard Researchers Explain Why

Pregnancy During Pandemic May Take a Toll on Your Mental Health: Harvard Researchers Explain Why
A growing body of evidence suggests that pregnancy is a risk factor for severe COVID-19. © Shutterstock.

A substantial proportion of pregnant and postpartum women are struggling with high levels of depression, anxiety, loneliness, and post-traumatic stress amidst the Covid-19 pandemic. Pregnancy can also increase risk of COVID-19 complications and death due to the disease.

Written by Longjam Dineshwori |Updated : April 23, 2021 1:38 AM IST

If you're pregnant and feeling emotionally distress, you're not alone. A large proportion of pregnant and postpartum women are struggling with mental health distress amidst the pandemic, according to a worldwide survey report published online in the journal PLOS ONE. The survey was conducted by researchers from Harvard University's T.H. Chan School of Public Health in the US and it included nearly 7000 women from 64 countries. They were surveyed online between May 26, 2020 and June 13, 2020. A substantial proportion of these women reported experiencing high levels of depression, anxiety, loneliness, and post-traumatic stress during the Covid-19 pandemic.

While the researchers had expected to see an increase in the proportion of pregnant and postpartum women reporting mental health distress during the pandemic, the number was found to be much larger than what had previously been published earlier. Of the 6,894 participants, 31 per cent of women scored at or above the cutoffs in widely used psychological screening tools for elevated levels of anxiety/depression, 53 per cent for loneliness, and 43 per cent for post-traumatic stress in relation to Covid-19. But only 117 women (2 per cent) were diagnosed with Covid-19 and 510 (7 per cent) were in contact with someone with Covid-19.

Reason for high levels of mental distress among pregnant women

Explaining the possible reasons for high levels of distress among pregnant and postpartum women during the pandemic, Karestan Koenen, Professor of psychiatric epidemiology at the Harvard University, said that "they are likely to be worried or have questions about their babies' health and development, in addition to their own or their family's health."

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News about the Covid-19 pandemic either from social media, news, or word-of-mouth also add to their stress. The more they seek information about the pandemic the more their odds of experiencing elevated post-traumatic stress in relation to Covid-19 and anxiety/depression. Worries about children and childcare and economic worries also contributed to their mental health distress, the researchers said, adding that such high levels of distress during pregnancy may have negative effect on development of the foetal and health of the mother.

Pregnancy and Covid-19: Potential risks for the mother and baby

Pregnancy can increase risk of COVID-19 complications for both women and their babies, said a study published today in JAMA Pediatrics. The risk of death due to Covid-19 was also higher for pregnant women with COVID-19, it added. Therefore, the authors of the study suggested considering pregnancy as a major risk factor for COVID-19 complications alongside the likes of obesity and asthma. For the study, Dr. Aris Papageorghiou, a fetal medicine specialist at Oxford University, and his team enrolled more than 2,000 pregnant women from dozens of hospitals around the world and followed them for eight months starting March 2. There were 706 pregnant COVID-19 patients and 1424 pregnant women without the disease.

Most of the women with COVID-19 were diagnosed during their third trimester of pregnancy. Pregnant women who were infected with COVID-19 were 76 per cent more likely to develop preeclampsia or eclampsia than pregnant women who did not have COVID-19. They were also more likely to develop a severe infection that required treatment with antibiotics (more than three times compared to pregnant women who did not have COVID-19) and to be admitted to a hospital's intensive care unit (five times as likely as pregnant women without Covid-19). What is more concerning is that women with COVID-19 had more than 22 times higher risk of death.

COVID-19 infection during pregnancy can also have negative affects on the babies. In the Oxford University study, the risk of preterm birth was found to be 59 per cent higher for mothers with COVID-19, and the risk of a medically indicated preterm birth was nearly double. Babies of COVID-19 patients faced a 2.66 times higher risk of severe illness after they were born and a 2.14 times higher risk of severe illness and death in the time just before and after birth, it said.

Among the babies born to women with coronavirus infections, 13 per cent tested positive for the virus, with more cases seen in cesarean delivery. However, the researchers found no association between breastfeeding and risk of a newborn testing positive. The findings add to the growing body of evidence that pregnancy is a risk factor for severe COVID-19. So, the researchers advise women to try and avoid getting COVID during pregnancy or avoid COVID by getting vaccinated.

Why pregnant women are more vulnerable to severe COVID-19?

Pregnancy leads to a host of immunologic and physiologic changes, including increased heart rate and oxygen consumption, decreased lung capacity, a higher risk of blood clots, and immunosuppression. These make them pregnant women more vulnerable to viral respiratory infections, including COVID-19, according to health experts.

In a recent study published in The BMJ, scientists from the United Kingdom underscored that pre-existing diabetes, chronic hypertension, asthma, smoking, gestational diabetes, preeclampsia, being aged 35 years or over, and having a body mass index (BMI) of 30 or above appear to increase the odds of severe COVID-19 in pregnant women and the need for admission to the intensive care unit (ICU). The US Centers for Disease Control and Prevention (CDC) also cautioned that pregnant women who have COVID-19 are more likely to develop respiratory complications requiring intensive care as well as more likely to be placed on a ventilator than women who aren't pregnant. Babies of mothers with COVID-19 also appear to be more likely to require admission to the neonatal intensive care unit (NICU). But researchers believe that this could be due to hospital policies for observation and quarantine of babies in contact with COVID-19.

Therefore, public health officials advise pregnant women to do all they can to avoid exposure to COVID-19. Take these precautions if you're pregnant:

  • Wash hands frequently with soap and water, specially before you eat, after you sneeze and after using the bathroom.
  • Limit contact with others as much as possible
  • Avoid close contact with anyone who is sick or has COVID-19 symptoms.
  • Always keep about 6 feet of distance between yourself and others outside of your family.
  • Wear mask in public places and at work (consider double-masking as experts say it can double the protection against the virus).

Are COVID-19 vaccines safe for pregnant women?

Because pregnant or breastfeeding women are considered a high-risk group, they were not enrolled in any of the recent COVID-19 vaccine trials. And therefore there is limited data on whether the vaccines are safe for pregnant women or their unborn babies. But some small studies have suggested that the current COVID vaccines are safe for both mother and child. For example, a preliminary study by the US CDC has found no evidence that the Pfizer-BioNTech or Moderna vaccines are unsafe during pregnancy.

Currently, India is using two vaccines' Covishield and Covaxin' to vaccinate its people against the deadly coronavirus. But women who are breastfeeding or pregnant and youngsters of less than 18 years are not recommended to take the anti-coronavirus vaccines at this time.

With inputs from agencies