How Did the Pandemic Affect Anxiety in Early Pregnancy?

Preexisting mental health conditions, COVID-specific stressors, and certain sociodemographic factors were associated with symptoms of anxiety in early pregnancy, according to a prospective observational study.

Among over 4,000 patients surveyed during the pandemic, a history of anxiety disorder was associated with a three times higher risk of reporting anxiety symptoms in early pregnancy after adjusting for sociodemographics (adjusted odds ratio [aOR] 3.16, 95% CI 2.23-4.46), reported Jerrine Morris, MD, MPH, of the University of California San Francisco.

COVID-specific concerns or experiences also played a significant role, Morris said in a virtual presentation at the American Society for Reproductive Medicine annual meeting.

Those who were very worried about COVID-19 had more than two times the risk of anxiety (aOR 2.43, 95% CI 1.77-3.33). And women who had a household contact deceased from COVID-19 during their pregnancy had a ninefold risk of reporting moderate to severe anxiety (aOR 9.40, 95% CI 1.75-50.43), although the prevalence in this population was low.

Sociodemographic characteristics associated with anxiety included younger age, lower household income, being unpartnered, and public or no pre-pregnancy insurance. Those who had less than a college degree had more than double the risk of moderate to severe anxiety (aOR 2.21, 95% CI 1.25-3.89).

Prior miscarriage and a history of depression were also associated with anxiety.

"Our study is one of the first to focus on anxiety symptoms in early pregnancy," Morris stated. "Future studies are essential to explore the continued differential impact of the pandemic on antenatal and postnatal anxiety symptoms among the most vulnerable populations."

Morris said that "continued emotional support should remain an important focus for providers," especially when they care for patients who are underserved, have a pre-existing history of anxiety, or are early in pregnancy when care may be limited.

In this prospective, observational study, the researchers analyzed data from the Assessing the Safety of Pregnancy in the Coronavirus Pandemic (ASPIRE) study to assess the prevalence of anxiety in early pregnancy in the pandemic and identify predictors.

From May 2020 to February 2021, patients who were at least 10 weeks' pregnant completed baseline and trimester-specific questionnaires, assessing sociodemographics, obstetric and medical history, and pandemic-related experiences. Researchers assessed anxiety at baseline via the Generalized Anxiety Disorder (GAD-7) questionnaire. Study participants also underwent weekly symptom screening and serologic testing.

Approximately 4,300 people completed the GAD-7 questionnaire, with 12.6% of those patients reporting anxiety. The mean age of patients in the study was 33 years old, and around a quarter received care at a fertility clinic.

Additional, COVID-specific factors associated with early pregnancy anxiety included pandemic-related job loss, reduced hours of work, inability to pay rent or mortgage, or loss of a friend or family member to COVID-19.

A history of anxiety was still associated with early pregnancy anxiety in the final adjusted model, but having less than a college education was no longer significant.

Comment