International Journal of Gynaecology and Obstetrics: the Official Organ of the International Federation of Gynaecology and Obstetrics, 160(1), 167-186, 2022
Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study
Kajdy A, Sys D, Pokropek A, Shaw SW, Chang TY, Calda P, Acharya G, Ben-Zion M, Biron-Shental T, Borowski D, Czuba B, Etchegaray A, Feduniw S, Garcia-Mandujano R, Santacruz MG, Gil MM, Hassan S, Kwiatkowski S, Martin-Arias A, Martinez-Portilla RJ, Prefumo F, Rabijewski M, Salomon LJ, Tiller H, Verlohren S, Voon HY, Yanque-Robles OF, Yong SL, Poon LC
To assess risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic using Mind-COVID, a prospective cross-sectional study that compares outcomes in middle-income economies and high-income economies.
Methods
A total of 7102 pregnant women from 12 high-income economies and nine middle-income economies were included. The web-based survey used two standardized instruments, General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9).
Result
Pregnant women in high-income economies reported higher PHQ-9 (0.18 standard deviation [SD], P < 0.001) and GAD-7 (0.08 SD, P = 0.005) scores than those living in middle-income economies. Multivariate regression analysis showed that increasing PHQ-9 and GAD-7 scales were associated with mental health problems during pregnancy and the need for psychiatric treatment before pregnancy. PHQ-9 was associated with a feeling of burden related to restrictions in social distancing, and access to leisure activities. GAD-7 scores were associated with a pregnancy-related complication, fear of adverse outcomes in children related to COVID-19, and feeling of burden related to finances.
Conclusions
According to this study, the imposed public health measures and hospital restrictions have left pregnant women more vulnerable during these difficult times. Adequate partner and family support during pregnancy and childbirth can be one of the most important protective factors against anxiety and depression, regardless of national economic status.
PMID 35932096 35932096 DOI 10.1002/ijgo.14388 10.1002/ijgo.14388
Cite this article
Kajdy, A., Sys, D., Pokropek, A., Shaw, S. W., Chang, T. Y., Calda, P., Acharya, G., Ben-Zion, M., Biron-Shental, T., Borowski, D., Czuba, B., Etchegaray, A., Feduniw, S., Garcia-Mandujano, R., Santacruz, M. G., Gil, M. M., Hassan, S., Kwiatkowski, S., Martin-Arias, A., . . . Mind-COVID Collaborative Team (2023). Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 160(1), 167-186. https://doi.org/10.1002/ijgo.14388
Kajdy A, Sys D, Pokropek A, Shaw SW, Chang TY, Calda P, et al. Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study. Int J Gynaecol Obstet. 2023;160(1):167-186. doi:10.1002/ijgo.14388
Kajdy, A., et al. "Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study." International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, vol. 160, no. 1, 2023, pp. 167-186.
Pregnant women are potentially a high-risk population during infectious disease outbreaks such as COVID-19, because of physiologic immune suppression in pregnancy. However, data on the morbidity and mortality of COVID-19 among pregnant women, compared to nonpregnant women, are sparse and inconclusive. We sought to assess the impact of pregnancy on COVID-19 associated morbidity and mortality, with particular attention to the impact of pre-existing comorbidity. We used retrospective data from January through June 2020 on female patients aged 18-44 years old utilizing the Cerner COVID-19 de-identified cohort. We used mixed-effects logistic and exponential regression models to evaluate the risk of hospitalization, maximum hospital length of stay (LOS), moderate ventilation, invasive ventilation, and death for pregnant women while adjusting for age, race/ethnicity, insurance, Elixhauser AHRQ weighted Comorbidity Index, diabetes history, medication, and accounting for clustering of results in similar zip-code regions. Out of 22,493 female patients with associated COVID-19, 7.2% (n = 1609) were pregnant. Crude results indicate that pregnant women, compared to non-pregnant women, had higher rates of hospitalization (60.5% vs. 17.0%, P < 0.001), higher mean maximum LOS (0.15 day vs. 0.08 day, P < 0.001) among those who stayed < 1 day, lower mean maximum LOS (2.55 days vs. 3.32 days, P < 0.001) among those who stayed ≥1 day, and higher moderate ventilation use (1.7% vs. 0.7%, P < 0.001) but showed no significant differences in rates of invasive ventilation or death. After adjusting for potentially confounding variables, pregnant women, compared to non-pregnant women, saw higher odds in hospitalization (aOR: 12.26; 95% CI (10.69, 14.06)), moderate ventilation (aOR: 2.35; 95% CI (1.48, 3.74)), higher maximum LOS among those who stayed < 1 day, and lower maximum LOS among those who stayed ≥1 day. No significant associations were found with invasive ventilation or death. For moderate ventilation, differences were seen among age and race/ethnicity groups. Among women with COVID-19 disease, pregnancy confers substantial additional risk of morbidity, but no difference in mortality. Knowing these variabilities in the risk is essential to inform decision-makers and guide clinical recommendations for the management of COVID-19 in pregnant women.
Wallace ME et al., 2026·American journal of public health
Objectives. To quantify the impact of state abortion bans on trends in fertility and preterm birth following the June 2022 US Supreme Court decision in Dobbs v Jackson Women's Health Organization. Methods. We tested for changes in birth rates and preterm birth rates occurring in the first 18 months following the Dobbs decision by fitting 2-way fixed effects and staggered difference-in-difference models to compare trends in states that banned abortion and those that did not. Results. We detected a statistically significant increase in the birth rate and preterm birth rate among non-Hispanic (NH) Black women above what would be expected in the absence of a ban, averaging a 3.5% increase in the birth rate and 2.1% higher incidence of preterm birth. Impacts were similar in analyses limited to births to women with Medicaid coverage, where trends among NH Black women in states that banned abortion were significantly elevated. Conclusions. The emerging impact of state laws that ban abortion has been uneven, with trends in birth rates and preterm birth increasing especially among NH Black women in states that banned abortion. (Am J Public Health. 2026;116(3):345-350. //doi.org/10.2105/AJPH.2025.308355).
Simultaneous intrauterine and rudimentary horn pregnancies are exceedingly rare, particularly when one arises from assisted reproduction and the other naturally. Early diagnosis is essential to prevent life-threatening complications, such as rudimentary horn rupture. Careful ultrasound evaluation is critical to detect subtle congenital uterine anomalies that may otherwise go unrecognised. A 39-year-old woman with primary infertility and multiple intramural fibroids conceived naturally and via intracytoplasmic sperm injection (ICSI). Her 43-year-old husband had oligo-astheno-teratozoospermia. After myomectomy and counselling, she underwent donor oocyte ICSI with her husband's sperm; the second cycle resulted in conception. Four weeks later, a transvaginal ultrasound confirmed a viable intrauterine pregnancy. At seven weeks, a second gestational sac was noted in the rudimentary horn. Three-dimensional ultrasound confirmed a unicornuate uterus with a non-communicating rudimentary horn unconnected to the cervical canal or main cavity. At 12 weeks, ultrasound-guided fetocide was performed using 0.2 mL of potassium chloride. The intrauterine pregnancy progressed uneventfully, culminating in a cesarean delivery at 34 weeks of a healthy female neonate weighing 2.3 kg. Both mother and infant remained well at the six-week follow-up. This case illustrates the rare coexistence of a natural rudimentary horn pregnancy and an ICSI-conceived intrauterine pregnancy in a unicornuate uterus. It highlights the importance of detailed, high-resolution imaging, vigilant antenatal surveillance, and timely multidisciplinary management to ensure favourable maternal and fetal outcomes.
Cesarean delivery is a major source of maternal morbidity, and repeat cesarean delivery accounts for 40% of cesarean delivery, but recent data on the trial of labor after cesarean and vaginal birth after cesarean are limited. This study aimed to report the national rates of trial of labor after cesarean and vaginal birth after cesarean by number of previous cesarean deliveries and examine the effect of demographic and clinical characteristics on these rates. This was a population-based cohort study using the US natality data files. The study sample was restricted to 4,135,247 nonanomalous singleton, cephalic deliveries between 37 and 42 weeks of gestation, with a history of previous cesarean delivery and delivered in a hospital between 2010 and 2019. Deliveries were grouped by number of previous cesarean deliveries (1, 2, or ≥3). The trial of labor after cesarean (deliveries with labor among deliveries with previous cesarean delivery) and vaginal birth after cesarean (vaginal deliveries among trial of labor after cesarean) rates were computed for each year. The rates were further subgrouped by history of previous vaginal delivery. Year of delivery, number of previous cesarean deliveries, history of previous cesarean delivery, age, race and ethnicity, maternal education, obesity, diabetes mellitus, hypertension, inadequate prenatal care, Medicaid payer, and gestational age were examined concerning the trial of labor after cesarean and vaginal birth after cesarean using multiple logistic regression. SAS software (version 9.4) was used for all analyses. The trial of labor after cesarean rates increased from 14.4% in 2010 to 19.6% in 2019 (P<.001). This trend was seen in all categories of number of previous cesarean deliveries. Moreover, vaginal birth after cesarean rates increased from 68.5% in 2010 to 74.3% in 2019. The trial of labor after cesarean and vaginal birth after cesarean rates were the highest for deliveries with a history of both 1 previous cesarean delivery and a vaginal delivery (28.9% and 79.7%, respectively) and the lowest for those with a history of ≥3 previous cesarean deliveries and no history of vaginal delivery (4.5% and 46.9%, respectively). Factors associated with the trial of labor after cesarean and vaginal birth after cesarean rates are similar, but several factors have different directions of effect, such as non-White race and ethnicity, which is associated with a higher likelihood of trial of labor after cesarean but a lower likelihood of successful vaginal birth after cesarean. More than 80% of patients with a history of previous cesarean delivery deliver by repeat scheduled cesarean delivery. With vaginal birth after cesarean rates increasing among those who attempt a trial of labor after cesarean, emphasis should be put on safely increasing the trial of labor after cesarean rates.