We thank Dr Olabisi Ogunbiyi for the interest and the important comments on our study.1
Our systematic review published at the end of March 2020 explored pregnancy and perinatal outcomes of coronavirus infections occurring during pregnancy, and therefore, it was limited to few case reports and series coming from China.1 The aim of this review was to help physicians make decisions based on the limited information available at that time, and these findings could be considered as an early answer to several urgent questions raised by specialists dealing with coronavirus disease 2019 (COVID-19) during pregnancy.1
Despite the relatively short time after the COVID-19 outbreak, a multitude of studies have been published, aiming to better elucidate the effect of this disease on both the physical and psychological health of pregnant women.2, 3, 4, 5
We agree and share Dr Olabisi Ogunbiyi’s concerns about the psychological impact of COVID-19 on pregnant women.
In an Italian cross-sectional survey aimed to assess the psychological response of 100 pregnant women at the beginning of the pandemic, the COVID-19 outbreak had a moderate psychological impact on women, with more than half of the respondents rating the psychological impact as severe and more than two-thirds reporting anxiety higher than normal, mostly in women in the first trimester of pregnancy and regarding the risk of vertical transmission.4
Dr Olabisi Ogunbiyi’s letter also highlighted other important issues that we should seriously take into account for maternal psychological well-being, such as women’s concerns about inadequate prenatal care and social isolation from support networks.
It is well known that life stressors might be exacerbated by the biological, social, and psychological changes occurring during pregnancy, and external stressors, such as a global pandemic, might even increase maternal stress during pregnancy.3
Mitigation measures adopted worldwide to reduce the impact of viral spread resulted in smart working from home, less physical and no shift work, better support systems from the partner and family, and more time for exercise and proper nutrition; in this scenario, positive benefits, such as the reduction of the incidence of preterm birth, have been shown by few reports.6
In our opinion, all pregnant women should undergo a thorough assessment of social and psychological well-being to better understand whether interventions, such as expressive writing, meditation, mindfulness, yoga, and physical exercise, would be enough to improve psychological outcomes or whether a dedicated in-person or online counseling performed by an experienced operator is required to improve women’s psychological health.
Moreover, women should be followed up not only during pregnancy but also in the early postpartum weeks, as suggested by the American College of Obstetricians and Gynecologists in the Committee Opinion on routine postpartum care that recommends a comprehensive postpartum visit no later than 12 weeks after birth, mostly focusing on mood and emotional well-being.7
Finally, further research on the effect of the pandemic on pregnant women with or without severe acute respiratory syndrome coronavirus 2 infection is necessary to evaluate the risk factors associated with adverse psychological outcomes and their effects on perinatal and long-term health.
Footnotes
The authors report no conflict of interest.
References
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