Table 8.

Perinatal mental health outcomes during COVID-19 as a function of factors not examined elsewhere.

Study	Study Design	Country	Study Period	Recruitment Sites/Methods	Participant Characteristics			Main Findings	Risk of biasa
					Pregnancy/ Postpartum Status	Key Variables Examined Or Subgroups	Maternal Age
Ahorsu et al. (116)	Cross-sectional	Iran	March–April 2020 (during the pandemic)	Health and household registration system	Pregnant women (GA: 15.04 (M) ± 6.00 (SD) weeks; n = 290) and their husbands (N = 580)	Fear of COVID-19, COVID-19 preventive behaviors, depression, anxiety, mental quality of life	29.24 (M) ± 5.84 (SD) years	Pregnant women's own or partner's fear of COVID-19 was associated with increased depressive symptoms and lower mental health quality during the pandemic.	6
Chaves et al. (117)	Cross-sectional	Spain	April 7–May 8, 2020 (during the pandemic)	Social media	Pregnant (n = 450) and postpartum (<6 months; n = 274) women (N = 724)	Life satisfaction, depression, anxiety	33.36 (M) ± 4.12 (SD) years	58% of participating women reported depressive symptoms and 51% of women reported anxiety symptoms. Risk factors (for life satisfaction): [pregnancy] poor perceived self-health, single/separated marital status, health practitioner occupation status; [postpartum] poor perceived self-health, baby's poor health, poor quality of baby's sleep, single/separated marital status	6
Ding et al. (118)	Cross-sectional	China	March 7–23, 2020 (during the pandemic)	Hospitals	Pregnant women (N = 817) • 1st trimester: n = 115 • 2nd trimester: n = 247 • 3rd trimester: n = 455	Knowledge, attitudes, and practices toward COVID-19, anxiety	29.1 (M) ± 4.0 (SD) years	20.8% of participating pregnant women reported anxiety. Risk factors: low knowledge of the impact of COVID-19 on pregnancy, fear of COVID-19 infection, distrust in media, previous children in the family	7
Gildner et al. (119)	Cross-sectional	United States of America	April–June 2020 (during the pandemic)	Social media	Pregnant women (N = 1,856) • GA: 26.1 (M) ± 8.62 (SD) weeks	COVID-related exercise change, depression	31.3 (M) ± 4.30 (SD) years	Pregnant women reporting COVID-related changes in their exercise routine had higher depressive symptoms. Women living in metro compared to rural areas were more likely to report changes to exercise routine.	7
Harrison et al. (120)	Cross-sectional	United Kingdom	May 1–June 1, 2020 (during the pandemic)	Social media	Pregnant women (N = 205) • 1st trimester: n = 70 • 2nd trimester: n = 69 • 3rd trimester: n = 66	Perceived social support, depression, anxiety, repetitive negative thinking, loneliness	18–24 years: n = 13 25–34 years: n = 129 35–44 years: n = 63	Pregnant women experiencing low levels of perceived support reported more depressive and anxiety symptoms, which were mediated by increased repetitive negative thinking and loneliness.	6
Jiang et al. (121)	Cross-sectional	China	February 5–28, 2020 (during the pandemic)	Hospital	Pregnant women (N = 1,873) • 1st trimester: n = 598 • 2nd trimester: n = 703 • 3rd trimester: n = 572	Access to prenatal care information, depression, anxiety, perceived stress	29 (M) ± 4.10 (SD) years	45.9% of participating pregnant women reported depression, 18.1% reported anxiety, and 89.1% reported stress. Those who accessed prenatal care during the pandemic were at lower risk of perceived stress, anxiety, and depression	7
Kachi et al. (122)	Cross-sectional	Japan	May 22–31, 2020 (during the pandemic)	Workplaces	Pregnant women (N = 359) • 8–13 weeks: n = 39 • 14–27 weeks: n = 140 • 28–41 weeks: n = 180	Maternity harassment (pregnancy discrimination; n = 89) vs. No maternity harassment (n = 270)	[maternity harassment]: 31.3 (M) ± 4.8 (SD) years [no harassment]: 31.2 (M) ± 4.6 (SD) years	1/4 of pregnant women experienced maternity harassment in the workplace. Pregnant women who experienced maternity harassment had a 2.5-fold higher prevalence of depression than those who had not experienced harassment.	6
Lin et al. (123)	Online cross-sectional	China	February 17–March 16, 2020 (during the pandemic)	Obstetric clinics and hospitals	Pregnant women (N = 751) • 1st trimester: n = 514 • 2nd trimester: n = 214 • 3rd trimester: n = 23	Sleep conditions during the pandemic, depression, anxiety	30.51 (M) ± 4.28 (SD) years	35.4% of participating pregnant women reported anxiety and 13.4% reported depression. Pregnant women with poor sleep quality/duration were at higher risk of depressive and anxiety symptoms.	7
Shahid et al. (124)	Cross-sectional	Pakistan	August 6–20, 2020 (during the pandemic)	Outpatient department of obstetrics and gynecology hospital	Pregnant women (N = 552) • GA: 25.3 (M) ± 10.4 (SD) weeks	Awareness and concerns about COVID-19, depression, anxiety	32 (M) ± 7.3 (SD) years	64% of pregnant women reported a high level of awareness and concern about the COVID-19 pandemic, and were at high risk of depression and anxiety	7
Thayer & Gildner (125)	Cross-sectional	United States of America	April 16–30, 2020 (during the pandemic)	Social media	Pregnant women (N = 2,099) • GA: 26.4 (M) ± 9.0 (SD) weeks	COVID-19 associated financial stress, depression	31.3 (M) ± 4.4 (SD) years	43% of participating pregnant women experienced COVID-19 related financial stress and 24% had clinically significant depression. Those with high financial stress were at high risk of clinically significant depression.	6
Zhang et al. (107)	Retrospective	China	April 11–May 25, 2020 (during the pandemic)	Hospitals	Postpartum women (<1 week; N = 878)	Emotional eating, changes in dietary patterns	R: 18–45 years	Postpartum women during the pandemic reported a dietary change and higher emotional eating. Risk factors (for emotional eating): high-risk residence status (Southern China and Wuhan), low exercise, and high concern about COVID-19	6

GA, gestational age; M, mean; SD, standard deviation; Med, median; R, range.

^aAssessed 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 10 points (lowest bias).