Abstract
Psychological symptoms during pregnancy and the postpartum period require special attention, particularly in the context of the COVID-19 pandemic. This study aims to evaluate the trajectory of psychiatric symptoms from pregnancy to the postpartum period during the COVID-19 pandemic. This prospective study was conducted at Babol University of Medical Sciences from February 2020 to September 2021. A total of 252 pregnant women completed the Symptom Checklist 25 (SCL-25), the Corona Disease Anxiety Scale, and the Post-Traumatic Stress Diagnostic Scale at both prenatal and postpartum time points. Results indicated that the mean total score of psychological symptoms decreased modestly from pregnancy to postpartum (39.61 ± 11.67 vs. 32.78 ± 12.15, p < 0.001). Additionally, symptoms of somatization, depression, anxiety, and phobia significantly declined from pregnancy to postpartum (p < 0.05). However, levels of depression, anxiety, and phobia remained significantly higher among women with a positive history of COVID-19 infection compared to those without, during both pregnancy and postpartum. While the overall mean score of psychological symptoms showed a slight reduction from pregnancy to postpartum, many symptoms persisted, particularly in individuals with a COVID-19 infection history or post-traumatic stress symptoms. The study recommends that healthcare providers, including obstetricians, nurses, and midwives, implement timely screening and treatment for psychological symptoms from pregnancy through postpartum.
Keywords: Psychological symptoms, Pregnancy, Postpartum, COVID-19
Introduction
Psychiatric illnesses are among the most prevalent morbidities associated with pregnancy and the postpartum period, carrying significant adverse effects for mothers, children, and families [1]. Pregnancy and early parenting increase vulnerability to mental health conditions, including depression, anxiety disorders, eating disorders, and psychosis [2]. Although postpartum psychosis has a relatively low incidence of approximately 1 in 1000 births [3], it is linked with severe adverse outcomes, including maternal and infant suicide [4].
The severity of symptoms and the potential risk of harm to both mother and child may necessitate hospitalization [3, 4]. Postpartum depression affects 10–15% of mothers, with some cases requiring hospitalization due to its intensity [2, 4]. Anxiety during pregnancy is also associated with adverse outcomes for both mother and child [4–6].
These disorders are often underdiagnosed, as their symptoms are frequently attributed to regular physiological or psychological changes during pregnancy [2, 7]. Concerns about potential side effects of medication contribute to inadequate treatment of these conditions [1]. It is crucial for all healthcare professionals, including nurses and midwives, who care for pregnant patients to be proficient in recognizing the subtle signs of maternal mental health disorders and familiar with available treatment options [4]. Early detection and effective interventions are essential to prevent severe outcomes for mothers, their children, and their families [7]. Moreover, early intervention can mitigate the impact of maternal mental health issues on individuals, families, and society [8].
Healthcare providers involved in reproductive health services should be adequately trained to recognize symptoms that may indicate mental health conditions and to provide appropriate psychological support and interventions [9].
The COVID-19 pandemic has likely exacerbated mental health symptoms during pregnancy and postpartum [10, 11].
Pregnant women and healthcare providers faced unique challenges in the early months of the pandemic, including fear of infection, quarantine measures, and anxiety related to hospital or clinic visits for medical care [11].
These additional stressors may have adversely impacted mental health and disrupted both personal and professional lives for many women [12, 13]. Studies have reported that 16 to 28% of pregnant women experienced anxiety or depression-related symptoms, with rates of these disorders notably higher during the COVID-19 pandemic compared to pre-pandemic levels [14–16]. Evidence suggests that the prevalence of severe depressive disorder and generalized anxiety disorder during pregnancy and postpartum increased beyond anticipated levels during the COVID-19 pandemic [14, 17]. Additionally, the immunosuppressive state of pregnancy places women at heightened risk for COVID-19 infection [18]. Concerns arose that the pandemic might restrict access to essential prenatal care, including delivery services, potentially increasing psychological stress and risk for severe mental health disorders in pregnant women [14, 15]. Previous studies on coronavirus infections, such as severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV), have shown that infected pregnant women are at increased risk for adverse pregnancy outcomes, including preterm birth and neonatal death [19, 20].
Given the global challenge posed by the COVID-19 pandemic and its far-reaching impact on various dimensions of health and daily life, especially its psychological effects on pregnant and postpartum women, there is a pressing need for further research in this area. This prospective study was therefore conducted to comprehensively evaluate the trajectory of psychiatric symptoms during pregnancy and the postpartum period within the context of the COVID-19 pandemic.
Methods
Study design and participants
This prospective study was conducted at Babol University of Medical Sciences during the COVID-19 pandemic, from February 2020 to September 2021. The study was approved by the ethics committee of the Babol University of Medical Sciences (IR.MUBABOL.HRI.REC 400.224). The study complied with the Declaration of Helsinki. Participants' names were not recorded. To ensure confidentiality, participants had the right to make an informed decision about participating in the research. All patients signed the written and informed consent forms at the beginning of the study.
Sampling was done among 252 pregnant women referred to obstetrics and gynecology outpatient clinics of Babol University of Medical Sciences educational-medical hospitals. Taking into account the assumption of 40% prevalence of depression in pregnant women after COVID-19 pandemic (14–16), taking into account 5% error at 95% confidence level and 80% power, the sample size of 195 pregnant women was obtained, which due to the presence of follow-up in the study and the possible dropout of 20%, it was decided to study 252 pregnant women.
Inclusion criteria included pregnant women with gestational age above 24 weeks after the inception of COVID-19 in Babol in February 2020, thus at least 18 years old, with an educational degree above primary school, and having enrollment satisfaction. Exclusion criteria included a positive history of severe psychiatric disorders (bipolar disorders, psychosis) with onset before their pregnancy period due to the problem of low cooperation in research.
The researchers received demographic information from all participants while preserving confidential elements. Based on the appendix of the demographic questionnaire, the history of medical diseases was considered and evaluated to investigate its effects on emotional symptoms, and the participants were also asked about their exposure to COVID-19 and the extent of their suffering from it. All participants were assessed by questionnaires on two occasions: first, at the prenatal visit in the 24th week up to the 40th week of pregnancy, and second, in the 2nd week up to the 6th week of the postpartum visit. This study aimed to investigate the trend of psychological symptoms in pregnancy and postpartum during the covid-19 pandemic.
Measurements
The questionnaires used in this study were demographic questionnaires about age, education, occupational status, etc., information about participants, and an appendix with questions about their medical conditions during pregnancy and the postpartum period. In addition, there were questions about their encounters with COVID-19 and the coronavirus. Also, this study included other tools, which are described below.
Symptom Checklist 25 (SCL-25): Symptom Checklist 90 (SCL-90) was made to assess pathological psychiatric symptoms in patients. Researchers applied a factorial load of 0.785 for every component and made a single factorial structure that explained 50.4% of the variance by 25 items. Eight main dimensions of SCL-25 included somatization, obsession-compulsion, interpersonal sensitivity and phobia (three statements for each of them), depression (two statements), anxiety (six statements), paranoid thought (one statement), and neuroticism (four statements), with one statement of Additional Items (ADI) without hostility dimension. Findings from an exploratory factor analysis using principal components and varimax rotations support a 7-factor structure for the SCL-25, which can account for 82.16 percent of the variance. Confirmatory factor analyses also support the 7-factor fundamental model's good fit. Moreover, there was a strong positive correlation between the SCL-25 subscales. Additionally, it generates high split-half coefficients (0.65 to 0.96) and Cronbach alphas (0.71 to 0.95) for subscales and the overall scale score [21].
Corona Disease Anxiety Scale (CDAS): 23 items, including those from the AIDS Anxiety Questionnaire and the Health Fear Questionnaire, were chosen to create Corona's Anxiety Scale. Five psychologists received a copy of the questionnaire to review the items' content validity. These subjects studied the items in terms of concept and whether they covered all aspects of the subject as well as the form of the scale. This scale was created and approved to assess the level of coronavirus anxiety in Iran. The final version of this instrument had 18 items and 2 factors; items 1 through 9 measured physical symptoms, and items 10 through 18 measured psychological symptoms. The respondents' minimum and maximum scores on this scale range from 0 to 54 because this instrument is scored on a 4-point Likert scale (never = 0, sometimes = 1, often = 2, and always = 3). High scores on this scale denote an individual's higher level of anxiety. For the Iranian population, this scale has the necessary validity and reliability [22].
Post-Traumatic Stress Diagnostic Scale (PDS): The scale is designed to test patients who identify as having experienced a traumatic event for the presence of PTSD and to evaluate the severity of symptoms and functioning in patients who have already been diagnosed with PTSD. The test can typically be finished in 10–15 min and is self-administered. No official scales to identify false or inconsistent responses are included in the PDS. The scale's reliability and validity were determined using samples between 18 and 65, and its Persian version was found suitable [23].
Statistical analysis
The data were analyzed using SPSS version 22. The standard deviation for quantitative and frequency data and ratio for qualitative data were utilized; an Paired t-test, Kruskal–Wallis, MANCOVA, and Spearman correlation coefficient, and the significance level was P < 0.05.
Ethical considerations
This article presents the findings of a research project conducted under the code of ethics IR.MUBABOL.HRI.REC 400.224. The study adhered to all ethical principles related to research, including obtaining informed consent from participants, ensuring anonymity, respecting autonomy, avoiding harm, and protecting the rights of the institution and researchers.
Results
In this study, 252 pregnant women referred to obstetrics and gynecology outpatient clinics were selected as participants and enrolled by a convenient sampling method. Twelve pregnant women were excluded because of their remarkable past psychiatric history, and the other 240 participants fulfilled the demographic and all other questionnaires clearly and concisely on two occasions: first at a prenatal visit in the 24th week up to the 40th week of pregnancy, and secondly in the 2nd week up to the 6th week of the postpartum period. Based on the participant's age, findings showed that the average age of pregnant women who entered the study was 29.60 ± 6.20 years in the range of 17–47 years.
Also, the average gestational age at the time of answering the questionnaires was 31.10 ± 4.84 weeks in the period between 20–40 weeks of pregnancy. The results of the analysis showed that only the global score of the psychological symptoms (SCL-25) was significantly lower (p-value = 0.031) in the postpartum period at younger ages (18–30 years) than older ages (> 31 years) and other questionnaires did not have significant differences based on the participant's age.
The data collected from the study showed that most of the mothers who entered the study had above diploma level of education (44.2%) and were housewives (76.7%). It is important to note that while education level was not significantly associated with changes in psychological symptoms (SCL-25 scores), this reflects a sample where a higher level of education may have offered psychological resilience or better access to healthcare. It was observed that 10% of the participants had a positive history of COVID-19. Around the effects of the level of education and the number of pregnancies, it was observed that the level of education and the number of pregnancies did not have a significant effect on any components of the psychological symptoms (SCL-25) questionnaire, and there was no difference between pregnancy and the postpartum period (P > 0.05). These demographic variables provide context for understanding the sample's psychological state. Even though education, occupation, and parity did not show significant effects in your statistical analysis, they describe the characteristics of the group and offer insight into the sample's generalizability and the external factors that may subtly influence mental health outcomes during pregnancy and postpartum.
Table 1 shows the comparison between the scores of SCL-25 subunits and also the Corona Disease Anxiety and PTSD questionnaires during pregnancy and the postpartum period. The paired T-test was used to investigate the changes in the SCL-25 score and its sub-units during pregnancy and after delivery. It was found that the sub-units of somatization, depression, anxiety, phobia, and the total score of SCL-25 during pregnancy were significantly higher than in the postpartum period (P < 0.05). However, in the sub-units of obsession, interpersonal sensitivity, and psychosis, there were no significant differences between pregnancy and the postpartum period.
Table 1.
Trend of psychological symptoms from pregnancy to postpartum
| Variable | Pregnancy | Postpartum | P-value |
|---|---|---|---|
| SCL-25 | |||
| Somatization | 11.43 ± 3.40 | 6.67 ± 1.48 | > 0.001 |
| Obsession | 4.52 ± 2.27 | 4.26 ± 2.23 | 0.055 |
| Interpersonal sensitivity | 4.75 ± 2.28 | 4.91 ± 2.83 | 0.245 |
| Depression | 1.39 ± 0.91 | 2.92 ± 1.59 | 0.006 |
| Anxiety | 2.23 ± 5.16 | 4.44 ± 2.12 | > 0.001 |
| Phobia | 4.16 ± 2.20 | 3.88 ± 1.88 | 0.031 |
| Psychosis | 3.30 ± 0.92 | 3.37 ± 1.25 | 0.290 |
| Total score of psychological symptoms (SCL-25) | 39.61 ± 11.67 | 32.78 ± 12.15 | > 0.001 |
| Corona disease anxiety | 1.30 ± 0.35 | 1.28 ± 0.99 | > 0.001 |
| Post traumatic stress disorder | 1.71 ± 1.10 | 1.15 ± 0.81 | > 0.001 |
Range scores: psychological symptoms:0–100/corona anxiety 0–5/pregnancy specific anxiety:0–34/PTSD:0–5
To investigate the trend of changes in the scores of the Corona disease anxiety and post-traumatic stress questionnaires during pregnancy and after delivery, the paired T-test was used, and it was observed that during pregnancy, the score of the Corona disease anxiety scale was significantly lower than in the postpartum period. However, the scores of the post-traumatic stress and pregnancy anxiety scales were significantly higher during pregnancy than in the postpartum period (P < 0.05).
Table 2 shows the relationship between changes in psychological symptoms (subunits of SCL-25 and their total score) in pregnant women with and without a history of COVID-19. It was observed that a positive history of infection with COVID-19 has a significant effect on the subunits of depression, anxiety, and phobia. However, it has no significant effect on other mental symptoms or the total score of the SCL-25 questionnaire, and there are no differences between pregnancy and the postpartum period (P > 0.05).
Table 2.
The relationship between changes in psychiatric symptoms of pregnant women with a positive history of COVID-19
| Subscale of SCL-25 | History of affected with COVID-19 | Standard deviation Mean ± (SD) |
P-value |
|---|---|---|---|
| Somatization | No | 3.43 ± 4.69 | 0.237 |
| Yes | 5.33 ± 4.02 | ||
| Obsession | No | 2.13 ± − 0.29 | 0.123 |
| Yes | 1.45 ± 0.04 | ||
| Interpersonal sensitivity | No | 2.09 ± 0.08 | 0.191 |
| Yes | 2.16 ± 0.79 | ||
| Depression | No | 1.04 ± − 0.14 | 0.036 |
| Yes | 1.13 ± 0.62 | ||
| Anxiety | No | 2.06 ± − 0.82 | 0.029 |
| Yes | 2.55 ± 0.020 | ||
| Phobia | No | 1.99 ± − 0.40 | 0.001 |
| Yes | 1.57 ± 0.83 | ||
| Psychosis | No | 0.95 ± 0.03 | 0.084 |
| Yes | 1.09 ± 0.37 | ||
| Global psychological score | No | 9.78 ± − 7.16 | 0.142 |
| Yes | 8.18 ± − 3.79 |
The relationship between the presence of illness during pregnancy and the changes in psychological symptoms after childbirth is shown in Table 3. The Kruskal–Wallis statistical test was used, and it was observed that the positive history of the disease has a significant effect on the components of somatization and psychosis (P-value = 0.012 and 0.014, respectively), and there is a significant difference between pregnancy and the postpartum period (P < 0.05).
Table 3.
The relationship between changes in psychiatric symptoms of pregnant women and the history of diseases in the current pregnancy
| The components of the SCL-25 | History of illness in the current pregnancy | *Standard deviation Mean ± (SD) |
P-value |
|---|---|---|---|
| Somatization | Not | − 4.24 ± 3.37 | 0.012 |
| Obstetrics and gynecology disease | − 5.55 ± 3.66 | ||
| Underlying disease | − 4.48 ± 2.45 | ||
| Comorbidity of obstetrics and gynecology disease and underlying disease | − 6.66 ± 4.57 | ||
| Other | 5.06 ± − 4.83 | ||
| Obsession | Not | 1.92 ± − 0.30 | 0.920 |
| Obstetrics and gynecology disease | 2.27 ± − 0.43 | ||
| Underlying disease | 1.50 ± − 0.10 | ||
| Comorbidity of obstetrics and gynecology disease and underlying disease | 2.69 ± 0.83 | ||
| Other | 3.30 ± 1.00 | ||
| Interpersonal sensitivity | Not | 1.93 ± 0.10 | 0.195 |
| Obstetrics and gynecology disease | 2.27 ± − 0.03 | ||
| Underlying disease | 1.71 ± 0.44 | ||
| Comorbidity of obstetrics and gynecology disease and underlying disease | 2.70 ± 0.25 | ||
| Other | 3.35 ± 0.83 | ||
| Depression | Not | 0.99 ± 0.18 | 0.994 |
| Obstetrics and gynecology disease | 1.05 ± 0.20 | ||
| Underlying disease | 1.16 ± 0.23 | ||
| Comorbidity of obstetrics and gynecology disease and underlying disease | 1.44 ± − 0.08 | ||
| Other | 0.98 ± 0.33 | ||
| Anxiety | Not | 1.49 ± 0.52 | 0.518 |
| Obstetrics and gynecology disease | 2.46 ± − 0.74 | ||
| Underlying disease | 2.83 ± 0.95 | ||
| Comorbidity of obstetrics and gynecology disease and underlying disease | 1.37 ± 1.08 | ||
| Other | 2.89 ± 1.25 | ||
| Phobia | Not | 1.22 ± − 0.34 | 0.395 |
| Obstetrics and gynecology disease | 2.18 ± − 0.29 | ||
| Underlying disease | 3.04 ± − 0.34 | ||
| Comorbidity of obstetrics and gynecology disease and underlying disease | 2.04 ± 0.01 | ||
| Other | 1.61 ± 0.33 | ||
| Psychosis | Not | 1.14 ± − 0.01 | 0.014 |
| Obstetrics and gynecology disease | 0.70 ± 0.12 | ||
| Underlying disease | 0.66 ± 0.17 | ||
| Comorbidity of obstetrics and gynecology disease and underlying disease | 0.99 ± − 0.41 | ||
| Other | 1.24 ± 0.58 | ||
| Total score | Not | 8.46 ± − 6.25 | 0.060 |
| Obstetrics and gynecology disease | 9.98 ± − 8.43 | ||
| Underlying disease | 9.78 ± − 5.78 | ||
| Comorbidity of obstetrics and gynecology disease and underlying disease | 10.23 ± 4.91 | ||
| Other | 15.76 ± 4.33 | ||
*The mentioned mean and standard deviation are related to the difference in the score during pregnancy and the postpartum period
Table 4 shows the correlation between the scores of psychiatric symptoms, Coronavirus anxiety, and Post-traumatic stress during pregnancy and the postpartum period. On the Corona anxiety questionnaire during pregnancy, it was observed that it has a significant and inverse correlation with the difference in the scores of somatization and phobia components (P-value = 0.001 and 0.030) during pregnancy, as well as a significant and positive correlation with the components of interpersonal sensitivity and depression (P-value = 0.002 and 0.001) of SCL-25. Concerning the correlation of the Corona anxiety questionnaire in the postpartum period, it was observed that it has a significant correlation with phobia (P-value = 0.030). Regarding the correlation of post-traumatic stress disorder, it was observed that there is a significant inverse correlation with the somatization component (P-value = 0.001) and a significant positive correlation with the interpersonal sensitivity component (P-value = 0.001). About the correlation of the post-traumatic stress questionnaire in the postpartum period, it was observed that there is a significant inverse correlation with the components of somatization, phobia, and the total score of psychological symptoms on the SCL-25 scale (P-values = 0.001, 0.018 and 0.006).
Table 4.
Correlation between psychiatric symptoms, coronavirus anxiety, and posttraumatic stress
| CDAS | CDAS | PTSD | PTSD | |
|---|---|---|---|---|
| Pregnancy | Postpartum | Pregnancy | Postpartum | |
| r (p-value) | r (p-value) | r (p-value) | r (p-value) | |
| Somatization | − 0.307 (0.001) | − 0.126 (0.051) | − 0.295 (0.001) | − 0.279 (0.001) |
| OCD | − 0.028 (0.668) | 0.084 (0.193) | 0.086 (0.185) | − 0.027 (0.680) |
| Interpersonal sensitivity | 0.109 (0.093) | 0.200 (0.002) | 0.225 (0.001) | 0.052 (0.420) |
| Depression | 0.034 (0.602) | 0.239 (0.001) | 0.125 (0.054) | − 0.008 (0.899) |
| Anxiety | − 0.016 (0.808) | 0.025 (0.698) | 0.036 (0.577) | − 0.122 (0.060) |
| Phobia | − 0.140 (0.030) | 0.030 (0.640) | − 0.085 (0.191) | − 0.152 (0.018) |
| Psychosis | 0.009 (0.890) | 0.080 (0.219) | 0.108 (0.097) | 0.003 (0.957) |
| Symptoms checklist | − 0.127 (0.050) | 0.048 (0.458) | − 0.031 (0.632) | − 0.176 (0.006) |
CDAS Corona Disease Anxiety Scale, PTSD Post Traumatic Stress Disorder
A variance analysis of factors predicting changes in psychological symptoms following childbirth is shown in Table 5. The MANCOVA analysis was used to investigate the predictive factors of postpartum psychological symptoms. It was observed that the results of the subunits of the psychological symptoms questionnaire and also the post-traumatic stress questionnaire, and the age of participants have a significant effect on the total score of postpartum psychological symptoms based on the SCL-25 scale (P < 0.05). In contrast, the results of corona disease anxiety have no significant effect on the total score of the SCL-25 (P < 0.05).
Table 5.
Influencing factors of changes psychiatric symptoms after childbirth
| Variable | Mean square | F | P-value | Observed power |
|---|---|---|---|---|
| Score of psychiatric symptoms of pregnancy | 3046.77 | 783.50 | < 0.001 | 1.00 |
| Corona anxiety | 0.022 | 0.001 | 0.985 | 0.51 |
| Post-traumatic stress disorder | 260.56 | 4.351 | 0.038 | 0.550 |
| Age | 268.28 | 4.480 | 0.035 | 0.562 |
Discussion
This present prospective study was conducted during the pandemic of COVID-19, among 252 pregnant women who were referred to the obstetrics and gynecology outpatient clinics to explore the course of psychiatric symptoms during their pregnancy and the postpartum period.
This study found a significant risk of somatization, anxiety, phobia, depression symptoms, and post-traumatic stress disorder during pregnancy, as well as a significant risk of Corona disease anxiety in the postpartum period. It was also found that the presence of medical illness in the current pregnancy has a significant effect on the components of somatization and psychosis, and the history of previous pregnancy diseases has a significant effect on the component of interpersonal sensitivity.
Another finding of this study was that depression, anxiety, and phobia are significantly higher in women with a positive history of COVID-19 disease, both during pregnancy and the postpartum period (P-value < 0.05). Our study is consistent with the findings of Maia Brik et al.'s research [24], which reported that the SARS-CoV-2 pandemic increased the symptoms of anxiety and depression among pregnant women, particularly affecting those with less social support. However, they did not assess the role of the level of education and occupational state of participants, and they also did not compare pregnancy and the postpartum period, which is inconsistent with our study. Yvonne J. kuipers et al. [25] conducted research and reported no differences in the GAD-2 score during pregnancy, but the postpartum total GAD-2 score before and during the pandemic showed significant differences. In their study, the COVID-19 pandemic seems to have a positive effect on postpartum women during the first year postpartum, particularly for those women who experienced emotional support. Their results were inconsistent with ours because we found a higher rate of anxiety in both pregnancy and the postpartum periods, and we also found a higher rate in pregnancy than postpartum, although the scale that they used was different from our study. Cultural and regional differences should also be considered, which could be the reasons for differences. Mo'ath F. Bataineh et al. [26] reported that the COVID-19 pandemic was associated with high rates of post-traumatic stress disorder, among pregnant women, with 58.6% of pregnant women reporting the presence of post-traumatic stress disorder. Their data was consistent with our results, which found a higher risk of suffering from PTSD in pregnant women, but we also found that its risk is higher during pregnancy than in the postpartum period.
Another superiority of our study was that we assessed the relationship of other psychological symptoms with PTSD and found the inverse relationship between PTSD and somatization symptoms, the direct relationship between PTSD and interpersonal sensitivity in pregnancy, and the inverse relationship between PTSD and somatization and phobia symptoms in the postpartum period. Our research is consistent with the Viviana Hamat et al. study [27], which reported a higher rate of anxiety and mental stress in pregnant women during COVID-19. However, on the other hand, they reported maternal age, gestational age, and low education as significant risk factors for suffering from anxiety and mental stress during pregnancy, which is inconsistent with our study. The difference between our study and theme can be due to cultural and regional differences.
In our research, we tried to have a comprehensive psychiatric approach for pregnant women; this is the superiority and priority of our study compared to previous studies. However, our study had some limitations. The lack of extended follow-up of women during their postpartum period because of the COVID-19 disease pandemic and its curfew was one of our limitations. We suggest designing similar studies evaluating psychiatric symptoms for a longer duration in the future, which can support the robustness of the data report.
Conclusion
This study identified a significant risk of somatization, anxiety, phobia, depression, and post-traumatic stress disorder in pregnant women, along with heightened anxiety related to COVID-19 in the postpartum period.
The findings also indicate that a history of COVID-19 infection is associated with elevated levels of depression, anxiety, and phobia, underscoring the need for targeted mental health support during pregnancy and postpartum to mitigate these symptoms and their consequences.
Although the overall mean score of psychological symptoms decreases modestly from pregnancy to postpartum, many symptoms remain stable, particularly in individuals with a history of COVID-19 and post-traumatic stress symptoms.
The study recommends timely screening and treatment of psychological symptoms by healthcare providers, including obstetricians, nurses, and midwives, from pregnancy through postpartum.
Acknowledgements
We thank all women who participated in the study.
Author contributions
AH, SB, and MF designed and conducted the project. SK analyzed the data. FH collected the data. SS wrote the primary draft of the paper. MF, SS, FK, and AH reviewed the manuscript. All authors read and approved the final manuscript.
Funding
This work was funded by Babol University of Medical Sciences (Grant No. 724133235).
Data availability
The datasets used in this study are available from the corresponding author up on reasonable request.
Declarations
Ethics approval and consent to participate
This study was approved by the Ethics Committee of Babol University of Medical Sciences (IR.MUBABOL.HRI.REC.400.224). Participant anonymity and confidentiality were guaranteed, and informed consent was obtained from all participants at the beginning of the study. All methods were conducted following the Declaration of Helsinki guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used in this study are available from the corresponding author up on reasonable request.