COVID-19 and emotional state in the perinatal period: a study of women accessing family planning services
What is it really like to become a mother during the pandemic? The international scientific evidence shows that symptoms of anxiety, depression and psychological distress have increased among pregnant and postpartum women, and highlights the need for appropriate interventions to support this population. For this reason, a study entitled “COVID-19 and perinatal mental health: the impact of COVID-19 on the emotional state and experiences of perinatal women accessing family planning services (FPSs)” was conducted between 2020 and 2021 and coordinated by the Istituto Superiore di Sanità. Launched in October 2020, the study involved women accessing FPSs provided by 9 health authorities in 8 Regions (Piedmont, Lombardy, Veneto, Emilia-Romagna, Tuscany, Lazio, Sardinia, Calabria): ASL TO3, ASST Fatebenefratelli Sacco, ASST Bergamo Est, Azienda ULSS 6 Euganea, AUSL di Bologna, Azienda USL Toscana Centro, ASL Roma 2, ASSL di Olbia and ASP Cosenza.
Between 1 October 2020 and 31 May 2021, 1168 pregnant women and 940 women up to six months postpartum took part in the study by completing an online questionnaire. Below are some of the findings from the study.
- Over 90% of the participants were Italian citizens, married or living with a partner. Most of them had a high level of education (Bachelor’s degree or higher), a job and were not struggling financially. Over 67% of respondents had not suffered obstetric complications, while 14% reported a past history of anxiety or mood disorders.
- Overall, 6% of pregnant women and 5% of mothers with children up to 6 months of age were infected with the virus.
Social support and support from healthcare professionals/services
- The study found that 32% of pregnant women and 38% of postpartum mothers did not feel supported by their social networks (before the pandemic, this percentage was just over 25%). Most of the participants described the support received from healthcare services and professionals as “appropriate”. However, the percentage of respondents who felt “not very well supported” was significantly higher among postpartum women (23%) than pregnant women (9%). More specifically, one in five women was not able to discuss their mood and feelings with a healthcare professional after being discharged from hospital.
Maternity care during the pandemic
- Concerns about the unborn baby’s health were expressed by 60% of pregnant women, and over 80% feared they might have to give birth without their partner present due to COVID-19 restrictions. Overall, 21% of mothers reported giving birth without their partner or a support person by their side.
Resources that were perceived as important during the pandemic
- Prompt responses to questions and concerns and increased availability of one-to-one meetings with maternity care professionals were described as important/very important by over 95% of the participants. Most pregnant and postpartum women considered it important/very important to have access to: stress management information (91% and 93%, respectively); a mental health professional (83% and 89%); peer support resources, including online support groups (79% and 81%), interaction with other pregnant women/new parents (92% and 94%) and experiences of other women who went through pregnancy, childbirth and the first postpartum months during the pandemic (84% and 85%).
- Symptoms of psychological distress were assessed using the Brief Symptom Inventory-18 (BSI-18). The percentage of participants with an overall score (Global Severity Index - GSI) of 25 or more (indicating clinically relevant symptoms) was higher among pregnant women (12%) than postpartum mothers (9%; p = 0.038).
Factors associated with clinically relevant psychological distress
- Among both pregnant and postpartum women, clinically relevant symptoms of psychological distress (GSI>25) were associated with economic hardship, past history of anxiety or mood disorders, low perceived support from social networks and maternity care professionals.
- No association was found between mental health and direct exposure to SARS-CoV-2 infection or living in areas with high spread of COVID-19.
This study is the only large-scale assessment of psychological distress in perinatal women accessing FPSs conducted in Italy during the pandemic. The overall prevalence of psychological distress appeared to be consistent with the findings of a large European study, based on an online survey of a sample population with similar socio-demographic characteristics, carried out shortly after the first wave of the pandemic reached its peak (Ceulemans et al, 2021).
The high percentage of participants reporting a lack of social support should be a cause for concern, as support networks are known to play a crucial role in mothers’ physical, mental and emotional wellbeing. The support provided to perinatal women by healthcare professionals and the capacity of maternity care services to meet women’s needs are extremely important in the unexpected and ever-changing scenario brought about by the health emergency.
Only 5% of the postpartum women taking part in the study were infected with SARS-CoV-2, but 20% of them reported giving birth without a support person by their side. Fewer women had to give birth without their partner present in areas with high spread of COVID-19 compared to other areas, which suggests that healthcare services in the Regions most affected by the first wave of the pandemic were better prepared.
Online participation may have introduced a selection bias. Italian women with a high level of education were over-represented compared to the wider population of perinatal women, whose profile is outlined by the Birth Summary Certificates (Certificati di Assistenza al Parto – CEDAP). Caution should therefore be used when generalizing the findings of this study.
Psychological distress in pregnancy and the first postpartum months increases the risk of negative health outcomes for both mothers and babies. Greater support should therefore be provided to the most vulnerable women going through the perinatal period during the pandemic, regardless of direct exposure to SARS-CoV-2. Only about 1 in 10 women showed clinically relevant symptoms of psychological distress, but changes to maternity care and reduced social support due to the COVID-19 epidemic were a concern to the vast majority of respondents, who expressed the need for more support from healthcare workers, increased availability of mental health services and improved access to self-help resources.
- Read the article “The Psychological Impact of COVID-19 among Women Accessing Family Care Centers during Pregnancy and the Postnatal Period in Italy”, published in Int. J. Environ. Res. Public Health 2022, 19(4), 1983; https://doi.org/10.3390/ijerph19041983
- Read the article “Mental health status of pregnant and breastfeeding women during the COVID-19 pandemic-A multinational cross-sectional study”. Acta Obstet Gynecol Scand. 2021;100(7):1219-1229. doi:10.1111/aogs.14092