Table 5.

The impact of COVID-19 on stress resilience and mental health in pregnant women.

Study	Population	Time period / wave	Study type and sample size	Objective(s)/Main outcomes	Inclusion criteria	Main findings/Summary
Nanjundaswamy et al., 2020	Indian obstetricians	April 5 - May 5 2020,	Cross-sectional, N = 118 (89.83% female)	COVID-19 related concerns expressed to obstetricians by pregnant and postpartum women	Unknown	40,86% of the participants reported anxieties related to social media. The most common anxieties and distress reported were related to worrying social media messages, fear about contracting the infection, social isolation, family members not following infection control and missing out on childbirth-related rituals.
Taubman-Ben-Ari et al., 2020	Israeli Jewish and Arab pregnant women	March 18–28 2020	Cross-sectional, N = 336 (n = 225 Jewish women, mean age 31.00 years (±5.18) and n = 111 Arab women, mean age 28.43 years (±3.89)	COVID-19 related distress and anxiety	Being pregnant and being able to complete questionnaires in Hebrew	Participating pregnant women reported high COVID-19- related anxiety, with leaving the home (taking public transportation or being in public places) being the greatest cause for concern. Specifically, the use of public transportation (87.5%) was reported as the cause of the highest anxiety, followed by the potential infection of other family members (71.7%), being in public places (70%), concern for the fetus (70%), going for pregnancy check-ups (68.7%), being infected themselves (59.2%), and the delivery (55.4%). Arab women were more distressed and anxious compared to Jewish women.
Zhang et al., 2020	Chinese pregnant women	February 13–16 2020	Cross-sectional, N = 1901 (mean age 28.9 years (±4.7)	Presence of prenatal depression (PND) and post-traumatic stress disorder (PTSD) during the COVID-19 pandemic	Being in the second or third trimester of pregnancy	During the early stage of the COVID‐19 outbreak, high anxiety levels, a high prevalence of probable PND (34%) and a high prevalence of suspected PTSD (40%) was observed among pregnant women.
Akgor et al., 2021	Pregnant women without psychiatric history attending an university clinic in Ankara, Turkey	May 2020 (precise period unknown)	Cross-sectional, N = 297 (mean age 27.64 years (±5.27))	The psychological impact and perceptions during the COVID-19 pandemic in pregnant women	Not having a psychiatric history	The majority of pregnant women in this study reported COVID-19 related concerns about their pregnancy and delivery (i.e. concerns about infecting their baby during delivery, not being able to reach their doctors and pregnancy complications because of canceled/postponed check-ups).
Medina-Jimenez et al., 2020	Mexican pregnant women	May 5 - June 12 2020,	Cross-sectional, N = 503 (mean age 28.1 years (±6.25))	The impact of the COVID−19 pandemic on the levels of stress (Perceived Stress Scale; PSS) and depression (Edinburgh's Postnatal Depression Scale; EPDS) of pregnant women in Mexico	Attending prenatal care from public and private hospitals	33.2% of the participants was highly stressed (having a score of 27 or higher on the PSS) and a significant increase in PSS scores was observed in the third trimester of pregnancy. 17.5% of the participating pregnant women were considered as being depressed (having a score of 14 or higher on de EPDS).
Zhang, & Ma, 2020	Chinese pregnant women residing in Liaoning Province	February - March 2020 (precise period unknown)	Cross-sectional, N = 560 (mean age 25.8 years (±2.7))	The attitude towards COVID-19, psychological and stress impact among pregnant women amid the COVID-19 pandemic's immediate wake	Having a Chinese nationality, being 18 years or older	During the early stages of the COVID-19 pandemic, Chinese pregnant women reported moderate-to-severe stressful and psychological impact of the pandemic.
Yassa, M. et al., 2020	Turkish pregnant woman at a single tertiary “Coronavirus Pandemic Hospital” referral center	April 2020 (precise period unknown)	Cross-sectional, N = 172 (mean age 27.5 years (±5.3))	The attitude, concerns, and knowledge of non-infected pregnant women towards the COVID-19 outbreak	Not being infected with COVID-19, not having a psychiatric history, having a confirmed pregnancy over the 30th gestational week	Women had a positive attitude and compliance towards the COVID-19 outbreak and the healthcare staff. However, the majority of the women also felt vulnerable and approximately one third of the pregnant women reported concerns about getting infected during or following the delivery or their new-born baby getting infected.
Shahid et al., 2020	Pakistani pregnant women at an out-patient clinic in Pakistan	August 6 −20, 2020	Cross-sectional, N = 552 (mean age 32.0 years (±7.3))	Levels of depression, anxiety and impact of the COVID-19 outbreak	Not having a psychiatric history or other comorbidities	61% of pregnant women neither felt depressed nor anxious and were likely to be well. 39% of pregnant women stated that the COVID‐19 pandemic had caused them depression and anxiety, while 33% were found to have possible depression, with EPDS scores of 10 or greater. Pregnancy was a determinant factor for negative perceptions of the COVID‐19 pandemic (e.g. being exposed, more vulnerable, and fearing vertical transmission or harm to the pregnant woman).
Liu, X. et al., 2020	Chinese pregnant women registered for prenatal care in Wuhan and Chongqing	February 3–9 2020	Cross-sectional, N = 1947 (n = 932 women form Wuhan, 90.45% aged <35 years, n = 1015 women from Chongqing, 87.78% aged <35 years)	The mental status (Self-Rating Anxiety Scale; SAS) of pregnant women and their obstetric decisions during the COVID-19 outbreak	Being registered for prenatal care in hospitals in Wuhan and Chiongqing	More women in Wuhan felt anxious (24.5% versus 10.4% of non-Wuhan women). Factors that influenced anxiety included household income, subjective symptom and attitudes. Overall, obstetric decisions also revealed city-based difference.
Lopez-Morales et al., 2021	Argentinian women	Three waves; T0 (March 22 - 25 2020), T1 (April 3–9 2020), T2 (May 6–10 2020) 2, 14, and 47 days after the start of the lockdown respectively	Prospective longitudinal case-control (3 waves), N = 204 (mean age 32.56 years (±4.71))	Psychopathological consequences of the COVID-19 pandemic in pregnant women, compared to non-pregnant women	Being older than 18 years, living in Argentina, not having serious physical/psychological diseases and absence of risk factors for COVID-19, for pregnant mothers: only having a single pregnancy (in any week of gestation)	In a time range of 50 days of quarantine, pregnant women showed a higher increase in depression, anxiety and negative affect and a higher decrease in positive affect compared to non-pregnant women.
Berthelot et al., 2020	Two cohorts of Canadian women (one pre and one post-COVID-19)	April 2–13 2020 (COVID-19 cohort)	Cross-sectional, N = 1754 (mean age 29.27 years (±4.23))	The extent to which the COVID-19 pandemic may aggravate the prenatal distress and psychiatric symptomatology of pregnant women	Being 18 years or older, having sufficient reading skills to complete self-report instruments	Pregnant women during the COVID-19 pandemic reported higher levels of depressive, anxiety, dissociative and PTSD symptoms, negative affectivity and less positive affectivity compared to a pre-COVID-19 cohort of pregnant women.
Yassa, M. et al., 2020	Turkish pregnant and non-pregnant woman at a single tertiary “Coronavirus Pandemic Hospital” referral center	April 2020 (precise period unknown)	Cross-sectional, N = 404 (mean age 27.4 years (±5.3))	State/trait anxiety and obsessive-compulsive symptoms during the COVID-19 pandemic of pregnant women compared to non-pregnant women	Not having a COVID-19 and psychiatric history	Pregnant women showed increased OCD symptoms and less severe anxiety levels compared with non-pregnant women.
Zhou, Y. et al., 2020	Chinese pregnant and non-pregnant women in several Maternal and Child Health Hospitals in Beijing during the epidemic of COVID-19	February 28 - March 12 2020,	Cross-sectional, N = 859 (n = 544 pregnant women, mean age 31.1 years (±3.9) and n = 315 non-pregnant women, mean age 35.4 years (±5.7))	The prevalence of depression, anxiety, physical discomfort, insomnia and post-traumatic stress disorder (PTSD) during the COVID-19 pandemic	Having a childbearing age	During the COVID/19 pandemic, pregnant women had lower scores of symptoms of depression, anxiety, and PTSD (all p < 0.05) compared to non-pregnant women.
Sade et al., 2020	Israeli women hospitalized in the high-risk pregnancy units of a University Medical Center in Israel	March 19 - May 26 2020,	Cross-sectional, N = 369 (n = 84 women hospitalized during COVID-19 (2.4% aged <20 years, 79.8% aged 20–35 years, 17.9% aged >35 years), and n = 270 women hospitalized before COVID-19 (4.3% aged <20 years, 82.4% aged 20–35 years, 13.3% aged >35 years))	The incidence of depression among women hospitalized in the high-risk units during the COVID-19 strict isolation period	Having a high-risk pregnancy	Results showed that women hospitalized in the high-risk pregnancy units during the COVID-19 pandemic had comparable risk for depression compared to the comparison group of high-risk pregnant women not hospitalized during the pandemic.
Ravaldi, et al., 2020	Italian pregnant women	March 18–31 2020	Cross-sectional, N = 737 (median age 34.4 years (range 18.4–47.4))	The association of concern, anxiety and PTSD symptoms with age, gestational weeks, parity, days of COVID-19 lockdown, assisted reproductive technology use, psychopathological history, and previous perinatal losses during the first period of lock-down	Being currently pregnant and being older than 18 years	Pregnant women were very concerned about COVID-19 and showed a high prevalence of anxiety and posttraumatic stress disorder symptom. Women with self-reported history of anxiety and/or depression were significantly more concerned about COVID-19 and were at a higher risk of developing symptoms of anxiety and posttraumatic stress disorder.
Liu, C. H. et al., 2021	US perinatal women	May 21 - August 17 2020,	Cross-sectional, N = 1123 (mean age 33.10 years (± 3.77))	COVID-19-related health, worries and grief, and depression, generalized anxiety and PTSD symptoms	Being older than 18 years, starting from the second trimester of pregnancy or having given birth in the past six months	Pre-existing mental health diagnoses as well as COVID-19-related health worries and grief experiences may increase the likelihood of mental health symptoms in perinatal women.
Yue, C. et al., C. 2020	Chinese pregnant women	February 16–21 2020	Cross-sectional, N = 308 (mean age 31.02 years (±3.9))	The relationship between social support, risk perception and anxiety among third-trimester pregnant women during the COVID-19 pandemic	Having a current pregnancy (third trimester)	The third trimester pregnant women had a high level of social support, a medium level of risk perception to COVID-19 and were susceptible to anxiety. Risk perception played a mediating role between social support and anxiety.
Dule, A. et al., A. 2021	Ethiopian pregnant mothers	August 1 −15, 2020	Cross-sectional, N = 384 (mean age 31.3 years (± 7.7))	The quality of life among pregnant mothers during COVID-19 and its association with social support and fear of the pandemic	Not having a high-risk pregnancy	Perceived social support was positively linked to quality of life and COVID-19-related fear impaired quality of life.
Khoury, et al., 2021	Canadian pregnant women	June 3 - July 31 2020,	Cross-sectional, N = 303 (mean age 32.13 years (±4.22))	The prevalence of mental health difficulties in pregnant individuals during the COVID-19 pandemic	Living in Ontario, Canada, being able to read and write in English, being 18 years or older, ≤ 36 weeks gestation	During the COVID-19 pandemic, pregnant women experienced significantly elevated symptoms of depression and anxiety and comparable rates of insomnia compared to a pre-COVID-19 sample of pregnant women.
Bo et al., 2020	Chinese women	February 22 - March 10 2020,	Cross-sectional, N = 1309 (mean age 29.99 years (±4.53))	The prevalence of depression (9-item Patient Health Questionnaire - PHQ-9) during the COVID-19 pandemic and its associated factors in women in the perinatal stages	Being a woman in the third semester of pregnancy, or post-partum period (from the beginning of pregnancy to one week after childbirth), being 18 years or older, not having a pre-existing psychiatric disorder	A high prevalence of depression in women across the perinatal stages was observed. Worries about infection and interrupted routine medical check-ups were associated with an increased risk of depression.
Durankus & Aksu, 2020	Turkish pregnant women	Not reported	Cross-sectional, N = 260 (mean age 29.56 years (±3.83)))	The effects of the COVID-19 pandemic on depression and anxiety in pregnant women, using the Edinburgh Postnatal Depression Scale (EPDS)	Not having a history of a psychiatric disorder	35.4% of the participating pregnant women scored higher than 13 on the EPDS and were thus being considered as being at risk of developing depression. COVID-19 pandemic effects regarding psychology and social isolation, anxiety symptoms and depressive symptoms contributed to increased depression in pregnant women.
Lebel et al., 2020	Canadian pregnant women	April 5–20 2020	Cross-sectional, N = 1987 (mean age 32.4 years (±4.2))	The prevalence of anxiety and depression symptoms in pregnant women during the COVID-19 pandemic and potential resilience factors associated with lower symptoms	Having a confirmed pregnancy (<35 weeks gestation)	Elevated symptoms of anxiety and depression were found among pregnant individuals during the COVID-19 pandemic; potential protective factors included increased social support and physical exercise.
Matsushima & Horiguchi, 2020	Japanese women	May 31 - June 6 2020,	Cross-sectional, N = 1777 (5.35% aged <25 years, 29.21% aged 25–30 years, 37.20% aged 30–34 years, 28.25% aged ≥35 years)	Depressive symptoms in pregnant women during the COVID-19 pandemic, using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS)	Being pregnant or recently gave birth (postpartum)	17% of pregnant women suffered from depressive symptoms. Depression scores were positively correlated with cancelation of planned informal support, higher perceived risk for infection, difficulties in household finances, lack of social support; being younger, being less wealthy, being unemployed, and not having a partner.
Mortazavi et al., 2021	Iranian pregnant women	May 5 - August 5 2020,	Cross-sectional, N = 484 (mean age 28.3 years (±5.8))	Well-being (WHO-5 Well-Being Index) of pregnant women and the effect of concerns and fears (Cambridge Worry Scale) on maternal well-being during the COVID-19 pandemic	Having a single healthy fetus and no significant psychological disorder	The percentage of women experiencing a low well-being state was relatively high. Predictors of experiencing low well-being were worry about own health, health of others and the fetus, having at least one infected person with COVID-19 among relatives.
Effati-Daryani et al., 2020	Iranian pregnant women	March - April 2020 (precise period unknown)	Cross-sectional, N = 205 (mean age 39.3 years (±5.5))	Depression, stress, and anxiety levels, and their predictive factors in pregnant women during the COVID-19 pandemic	Having a file in the health centers of Tabriz, having a mobile phone and a healthy pregnancy, not having a history of mental illness, medical problems during pregnancy, and high-risk pregnancies	Higher depression, stress and anxiety levels were correlated with education level, spouse's support and job, marital life satisfaction, number of pregnancies, household income sufficiency.
Lin et al., 2021	Chinese pregnant women	February 17 - March 16 2020,	Cross-sectional, N = 751 (mean age 30.51 years (±4.28))	Mental manifestations of the COVID-19 pandemic and the impact of sleep conditions on mental health status	Not having a severe physical or mental disorder	A notable proportion of pregnant women exhibited mild anxiety and depression symptoms during the epidemic of COVID-19 mediated by sleep conditions.
Gur et al., 2020	US pregnant women	April 17 - May 1 2020,	Cross-sectional, N = 787 (mean age 32.45 years (±4.83), 27.4% Black, 72.6% White-Non Latina/Hispanic)	Race-related differences in COVID-19-related burden on mental health and resilience factors	Being pregnant	Significant racial disparities were observed regarding the impact of the COVID-19 pandemic and the experience of healthcare on the well-being of pregnant women. Self-reliance and emotion regulation was higher in Black women, although not related to a reduced risk for depression.
Ahorsu et al., 2020	Iranian pregnant women	March 7 - April 21 2020,	Cross-sectional, N = 580 (n = 290 pregnant women, mean age 29.54 years (± 5.84) and n = 290 husbands, mean age 33.62 years (±6.36))	The interdependencies between fear of COVID-19, mental health, and preventive COVID-19 behaviours	Being pregnant, being 18 years or older, being enrolled in the Integrated Health System (IHS), having a husband who agrees to participate	Significant dyadic relationships were observed between husbands and their pregnant wives' fear of COVID-19, mental health, and preventive behaviours.