Table 2.
Mental health outcomes in pregnant or postpartum women before vs. during the COVID-19 pandemic.
| Study | Study Design | Country | Recruitment Sites/Methods | Participant Characteristics | Main Findings | Risk of Biasb | ||
|---|---|---|---|---|---|---|---|---|
| Subgroups | Pregnancy/ Postpartum Status |
Maternal Age | ||||||
| Ayaz et al. (72) | Cross-sectional | Turkey | Outpatient prenatal clinic | Pandemic (April 12–May 27, 2020; n = 63) vs. Pre-pandemic (June 2018-; end date and n: NR) | Pregnant women (N = 63) • GA: 32.5 (M) ± 7 (SD) weeks |
30.4 (M) ± 5.3 (SD) years | Pregnant women reported more depressive and anxiety symptoms during compared to before the pandemic. Risk factors: obesity, negative relationship with husband | 8 |
| Berthelot et al. (73) | Case-control/ Longitudinal |
Canada | Social media and prenatal clinics | Pandemic (April 2020; n = 1,258) vs. Pre-pandemic (April 2018–March 2020; n = 496) | Pregnant women (N = 1,754) • GA: [pandemic] 24.38 (M) ± 9.2 (SD) weeks; [pre-pandemic] 25.8 (M) ± 9.73 (SD) weeks |
29.27 (M) ± 4.23 (SD) years | Pregnant women reported more severe symptoms of depression, anxiety and PTSD during compared to before the pandemic. | 7 |
| Cameron et al. (74) | Cross-sectional | Canada | Social media | Pandemic (April 14–28, 2020; n = 312) vs. Pre-pandemic (specific dates: NR; n = 312) | Postpartum women ( ≤ 0–18 monthsa; N = 312) |
34.28 (M) ± 5.02 (SD) years | 34.09% of postpartum women reported depressive symptoms and 34.55% reported anxiety symptoms during the pandemic. Postpartum women reported increased depressive and anxiety symptoms during compared to before the pandemic. | 5 |
| Davenport et al. (75) | Cross-sectional | Canada | Social media | Pandemic (April 14–May 8, 2020; n = 900) vs. Pre-pandemic (retrospective recall; n = 900) | Pregnant (N = 520) and postpartum (<1 year; n = 380) women (N = 900) | Med = 33 (R = 17–49) years | 15% and 40.7% of participating women met criteria for depression before and during the pandemic, respectively. 39% and 72% of women met criteria for moderate to high anxiety before and during the pandemic, respectively. Protective factor: (for depression and anxiety) 150+ mins of physical activity | 8 |
| Hui et al. (76) | Retrospective | Hong Kong (People's Republic of China) | Hospital | Pandemic (January 5, 2020–April 30, 2020; n = 954) vs. Pre-pandemic (January 1, 2019–January 4, 2020; n = 3,577) | Postpartum women (N = 4,531) • GA: [pandemic] 38.5 (M) ± 2.29 (SD) weeks; [pre-pandemic] 38.5 (M) ± 2.25 (SD) weeks |
[Pandemic]: 33.1 (M) ± 4.6 (SD) years [Pre-pandemic]: 33.1 (M) ± 4.4 (SD) years |
Women who delivered during compared to before the pandemic reported higher depressive symptoms. | 6 |
| Loret de Mola et al. (77) | Longitudinal | Brazil | Hospitals | Pandemic 1st wave (May–July 2020) vs. Pandemic 2nd wave (July–December 2020) vs. Pre-pandemic (2019) | Pregnant women (N = 591) |
NR | In participating pregnant women, depression prevalence rose from a pre-pandemic rate of 3.1% to 28.4% during the first wave in 2020, and to 30.6% during the second wave of the pandemic. Anxiety increased from 9.6% (pre-pandemic) to 26.7% (1st wave), to 28.8% (2nd wave), with a 3-fold increase in prevalence. | 4 |
| Matvienko-Sikar et al. (78) | Cross-sectional | Ireland | Social media and hospital |
Pandemic (June 16–July 17, 2020; n = 235) vs. Pre-pandemic (May 2019–February 2020; n = 210) |
Pregnant women (N = 445) • GA: [pandemic] 27.49 (M) ± 8.60 (SD) weeks; [pre-pandemic] 26.43 (M) ± 10.09 (SD) weeks |
[Pandemic]: 33.67 (M) ± 4.47 (SD) years [Pre-pandemic]: 33.91 (M) ± 4.05 (SD) years |
Participating pregnant women reported higher stress during compared to before the pandemic. Risk factors: perceived low social support, low physical activity | 7 |
| Mayopoulous et al. (79) | Cross-sectional | United States of America | Social media, professional organizations, and hospitals |
Pandemic (March–April 2020; n = 1,611) vs. Pre- pandemic (early in 2020 [specific dates NR]; N = 637) |
Postpartum women (N = 1,274) |
32.0 (M) years | Postpartum women reported higher acute stress during compared to before the pandemic. Higher acute stress during birth was significantly associated with increased childbirth-related PTSD symptoms and decreased infant bonding. | 8 |
| McFarland et al. (80) | Population-based | United States of America | Records for live births |
Pandemic vs. Pre- pandemic (Time matched samples [N = 18,531]: September 2019–April 2020; Month-matched samples [N = 18,346]: January 2019–April 2019 and January 2020–April 2020) |
Pregnant women (N = 32,352) |
(R) <20 years: n = 647 20–34 years: n = 22,970–23,617 35+ years: n = 7,764–8,735 |
Pregnant women who gave birth during compared to before the pandemic reported elevated depressive symptoms. | 7 |
| Moyer et al. (81) | Cross-sectional | United States of America | Social media |
Pandemic (April 3–24, 2020; n = 2,740) vs. Pre-pandemic (retrospective recall; n = 2,740) |
Pregnant women (N = 2,740) • 3rd trimester: n = 1,128 |
M = 32.7 years | Pregnant women reporting more COVID-19 related stressors had the greatest changes in pre- to post- pregnancy-related anxiety. Risk factors: lack of face-to-face prenatal visits, change in birth plans away from in-hospital delivery, fear of running out of food, increased conflict at home, fear of infection, essential worker status (self or family member), COVID-19 high-risk area resident status, loss of childcare, loss of job, low education levels, previous mental health disorder | 8 |
| Pariente et al. (82) | Cohort | Israel | Hospital | Pandemic (March 18–April 29, 2020; n = 223) vs. Pre- pandemic (November 2016–April 2017; n = 123) | Postpartum women (N = 346) • GA: [pandemic] 39.4 (M) ± 1.0 (SD) weeks; [pre-pandemic] 39.4 (M) ± 0.9 (SD) weeks |
[Pandemic]: 29.1 (M) ± 5.1 (SD) years [Pre-pandemic]: 28.3 (M) ± 5.0 (SD) years |
Women delivering during compared to before the pandemic had lower risk of developing postpartum depression. | 6 |
| Sade et al. (83) | Cross-sectional | Israel | Hospital | Pandemic (March 19–May 26, 2020; n = 84) vs. Pre-pandemic (November 2016–April 2017; n = 279) | Pregnant women in high-risk obstetric units (N = 363) • GA: [pandemic] 33.7 (M) ± 5.1 (SD) weeks; pre-pandemic 34.0 (M) ± 4.8 (SD) weeks |
[Pandemic]: (R) <20 years: n = 2 20–35 years: n = 67 >35 years: n = 15 [Pre-pandemic]: (R) <20 years: n = 12 20–35 years: n = 230 >35 years: n = 37 |
No difference was found in depression and suicidal ideations in pregnant women in high-risk obstetric units during compared to before the pandemic | 8 |
| Silverman et al. (84) | Cross-sectional | United States of America | Obstetric clinics | During social restrictions (March 13–June 30, 2020; n = 252) vs. Before social restrictions (January 2–March 12, 2020; n = 264) | Postpartum women (N = 516) |
R = 19–48 years | Postpartum women with low socio-economic status reported significantly fewer depressive symptoms after compared to before social restrictions were imposed. | 6 |
| Silverman et al. (85) | Cross-sectional | United States of America | Obstetric clinics | During social restrictions (May 4–June 12, 2020; n: NR) vs. Before social restrictions (February 2–March 11, 2020; n: NR) | Pregnant women receiving government-funded healthcare (i.e., low socio-economic status; N = 485) | R = 16–40 years | Pregnant women of low socio-economic status reported improved mood after compared to before social restrictions were imposed. | 6 |
| Sinaci et al. (86) | Cross-sectional | Turkey | High-risk pregnancy clinic |
Pandemic (May–July 2020; n = 446) vs. Pre-pandemic (retrospective recall; n = 446) |
Pregnant women (N = 446) • GA: 24.53 (M) years |
Med = 28.93 R = 23.22–34.61 years |
Participating pregnant women reported significantly higher trait anxiety during compared to before the pandemic. Risk factor: high-risk pregnancy | 6 |
| Suzuki (87) | Case-control | Japan | Postpartum outpatient clinic | Pandemic (March–April 2020; n = 132) vs. Pre- pandemic (March–April 2019; n = 148) | Postpartum women (N = 280) |
R = <19 to >40 years | No difference was found in postpartum women's depressive symptoms before and during the pandemic. Postpartum women reported a decrease in mother-infant bonding during compared to before the pandemic. | 7 |
| Wu et al. (88) | Cross-sectional | China | Obstetric clinic |
After COVID-19 declaration (January 20–February 9, 2020; n = 1,285) vs. Before COVID-19 declaration (January 1–20, 2020; n = 2,839) |
Pregnant (3rd trimester) women (N = 4,124) | Med = 30 (R = 27–32) years | Pregnant women reported greater depression and self-harm after compared to before the COVID-19 declaration. Risk factors (for depression): increased information about COVID-19 and number of positive cases | 6 |
| Xie et al. (89) | Cross-sectional | China | Social media; Hospitals | Pandemic (January–August 2020; n = 689) vs. Pre-pandemic (March–December 2019; n = 2,657) | Pregnant women (N = 3,346) • GA: [pandemic] 16.10 (M) ± 5.0 (SD) weeks; [pre-pandemic] 16.24 (M) ± 5.0 (SD) weeks |
[Pandemic]: 29.03 (M) ± 4.9 (SD) years [Pre-pandemic]: 28.94 (M) ± 6.4 (SD) years |
Women pregnant during compared to before the pandemic reported greater depression, anxiety, and somatization, as well as lower family cohesion. | 8 |
| Zanardo et al. (90) | Case-control | Italy | Online |
Pandemic (March 8–May 3, 2020; n = 91) vs. Pre-pandemic (March–May 2019; n = 101) |
Postpartum women (N = 192) • GA: [pandemic] 39.41 (M) ± 1.12 (SD) weeks; [pre-pandemic] 39.42 (M) ± 1.14 (SD) weeks |
[Pandemic]: 33.73 (M) ±5.01 (SD) years [Pre-pandemic]: 32.98 (M) ±5.07 (SD) years |
Postpartum women reported higher depression during compared to before the pandemic. | 7 |
GA, gestational age; M, mean; SD, standard deviation; Med, median; R, range; PTSD, post-traumatic stress disorder; NR, not reported.
a
This study covered children aged 0–8 years, but our data reviewed here only pertains to 0–18 months range.
b
Assessed using a modified version of the Newcastle-Ottawa Scale (54). See section Assessment of Risk of Bias for details. Scores range from 0 (highest bias) to 9 points (lowest bias).