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      Perinatal depressive and anxiety symptoms of pregnant women along with COVID-19 outbreak in China

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      American Journal of Obstetrics and Gynecology
      The Author(s). Published by Elsevier Inc.
      COVID-19, perinatal depression, perinatal anxiety, Edinburgh Postnatal Depression Scale

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          On January 20, 2020, a new coronavirus epidemic with “human-to-human” transmission was officially announced by the Chinese government, which caused significant public panic in China. Pregnant women may be particularly vulnerable and in special need for preventative mental health strategies. Thus far, no reports exist to investigate the mental health response of pregnant women to the COVID-19 outbreak.


          The aim of the present study is to examine the impact of COVID-19 outbreak on the prevalence of depressive and anxiety symptoms and the corresponding risk factors among pregnant women across China.

          Study Design

          A multi-center cross-sectional study was initiated in early December 2019 to identify mental health concerns in pregnancy using the Edinburgh Postnatal Depression Scale (EPDS). This study provided a unique opportunity to compare the mental status of pregnant women before and after the announcement of the COVID-19 epidemic. A total of 4124 pregnant women during their third trimester from 25 hospitals in 10 provinces across China were examined in this cross-sectional study from January 1 to February 9, 2020. Of these women, 1285 were assessed after January 20, 2020 when the coronavirus epidemic was publically announced and 2839 were assessed before this pivotal time point. The internationally recommended EPDS was used to assess maternal depression and anxiety symptoms. Prevalence rates and risk factors were compared between the pre and post study groups.


          Pregnant women assessed after the declaration of COVID-19 epidemic had significantly higher rates of depressive symptoms (26.0% vs 29.6%, P=0.02) than women assess pre-epidemic announcement. These women were also more likely to endorse thoughts of self-harm ( P=0.005). The depressive rates were positively associated with the number of newly-confirmed COVID-19 cases ( P=0.003), suspected infections ( P=0.004), and death cases per day ( P=0.001). Pregnant women who were underweight pre-pregnancy, primiparous, < 35 years old, employed full-time, middle income, and had appropriate living space were at increased risk to develop depressive and anxiety symptoms during the outbreak.


          Major life-threatening public health events such as the COVID-19 outbreak may increase the risk for mental illness among pregnant women including thoughts of self-harm. Strategies targeting maternal stress and isolation such as effective risk communication and the provision of psychological first aid may be particularly useful to prevent negative outcomes for women and their fetuses.

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          Author and article information

          Am J Obstet Gynecol
          Am. J. Obstet. Gynecol
          American Journal of Obstetrics and Gynecology
          The Author(s). Published by Elsevier Inc.
          11 May 2020
          11 May 2020
          [1 ]The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
          [2 ]Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
          [3 ]Shaoxing Maternity and Child Health Care Hospital, Shaoxing, Zhejiang, China
          [4 ]Hangzhou Women’s Hospital, Hangzhou, Zhejiang, China
          [5 ]Dalian Maternal and Childcare Health Hospital, Dalian, Liaoning, China
          [6 ]Wenzhou People's Hospital, Wenzhou, Zhejiang, China
          [7 ]Jiashan Maternity and Child Health Care Hospital, Jiaxing, Zhejiang, China
          [8 ]Fuzhou Maternal and Child Health Care Hospital, Fuzhou, Jiangxi, China
          [9 ]Songjiang Maternity and Child Health Hospital, Shanghai, China
          [10 ]Hunan Maternal and Child Health Care Hospital, Changsha, Hunan, China
          [11 ]Affiliated Hospital of Yan’an University, Yan’an, Shaanxi, China
          [12 ]Enze Obstetrics and Gynecology Hospital Affiliated to Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang, China
          [13 ]Taizhou Hospital of Zhejiang Province, Taizhou, Zhejiang, China
          [14 ]Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
          [15 ]Hainan Women and Children's Medical Center, Haikou, Hainan, China
          [16 ]First People’s Hospital of Wuhu City, Wuhu, Anhui, China
          [17 ]People's Hospital of Changshan, Quzhou, Zhejiang, China
          [18 ]Shengzhou Maternity and Child Health Hospital, Shengzhou, Zhejiang, China
          [19 ]Wenchang Maternity and Child Health Care Hospital, Wenchang, Hainan, China
          [20 ]Huzhou Maternity and Child Health Care Hospital, Huzhou, Zhejiang, China
          [21 ]Karamay Central Hospital of XinJiang, Xinjiang, China
          [22 ]Ningbo Yinzhou People's Hospital, Ningbo, Zhejiang, China
          [23 ]Fuyang Women and Children’s Hospital, Hangzhou, Zhejiang, China
          [24 ]Ningbo Women and Children's Hospital, Ningbo, Zhejiang, China
          [25 ]Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, Hangzhou, Zhejiang, China
          [26 ]Ningbo University Affiliated Hospital of Medical School, Ningbo, Zhejiang, China
          [27 ]School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
          [28 ]Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
          [29 ]Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
          [30 ]Chinese Maternal and Child Health Association, Beijing, China
          Author notes
          [# ] Correspondence: He-Feng Huang, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, No. 910, Rd. Hengshan, Shanghai 200030, China. ORCID: 0000-0003-4344-8019. Tel: +86-21-64070434. . huanghefg@ 123456sjtu.edu.cn

          Contributed equally

          © 2020 The Author(s)

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.


          Obstetrics & Gynecology
          covid-19,perinatal depression,perinatal anxiety,edinburgh postnatal depression scale


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